Are you treating your loved one like a “Third Party Patient”?

When you take your loved one to the doctor’s office, are you making sure that you are keeping the person with diminished capacity involved in the office visit? Too often, the doctor starts talking to the patient’s family or caregiver and forgets that the patient is in the room. Or sometimes we forget that our loved one is still here and begin to make all of their decisions for them. This is what is called, “Making the person a third party patient.” It is seems like the patient has become invisible.

I know this has happened in my family. Many times, my dad’s doctor would ask me in front of my dad, “How is your dad feeling today?” Then I would say, “I don’t know, ask him.” Or when I would take my aunt, who was in a wheelchair, out for lunch, people would say to me, “What would your aunt like to eat?” And once again I would say, “I don’t know, ask her.” We have to remind people that our loved one is still here. Even if the person has lost some of their ability to think and communicate, that doesn’t mean that he or she shouldn’t be included. Yes, the person with diminished capacity will not be making the final decisions about medical treatment choices, but the individual can still voice his or her opinion.

I know that it may not be easy and it may take more time, but we need to keep the person included. The person deserves our attention and our effort. Face the patient, ask the person questions and be patient when waiting for the answer. Explain to the person what will be happening to him or her in language that can be understood. It is important to include the person for as long as possible and when it is safe to have them have a voice in the decisions.

Have a kind and respectful day.

Stopping the “Third Party Patient” problem.

When a person with diminished capacity comes in for an office visit, do you remember to include the person in the conversation or do you take the easy way and just talk to the patient’s family or caregiver? Unfortunately, sometimes we forget that patient is still there and allow the caregiver to speak for them. This is what is called, “Making the person a third party patient.” The patient losses his or her own voice and becomes invisible to the healthcare professional and the caregiver.

I know this has happened in my family. Many times, my dad’s doctor would ask me in front of my dad, “How is your dad feeling today?” Then I would say, “I don’t know, ask him.” Or when I would take my aunt, who was in a wheelchair, out for lunch, people would say to me, “What would your aunt like to eat?” And once again I would say, “I don’t know, ask her.” We have to remind people that our loved one is still here. Even if the person has lost some of their ability to think and communicate, that doesn’t mean that he or she shouldn’t be included. Yes, the person with diminished capacity will not be making the final decisions about medical treatment choices, but the individual can still voice his or her opinion.

I know that it may not be easy and it may take more time, but we need to keep the person included. The person deserves our attention and our effort. Face the patient, ask the person questions and be patient when waiting for the answer. Explain to the person what will be happening to him or her in language that can be understood. It is important to include the person for as long as possible and when it is safe to have them have a voice in the decisions.

Have a kind and respectful day.

The Pajama Story

The Pajama Story

My friend, Gail, told me the most touching story the other day. A lovely lady was a devoted and loving wife to her dying husband. She did everything for him at home but as the end neared, she had to admit her husband to an inpatient hospice facility so he could get more help managing his symptoms. This ended up being the best thing for both of them. She told my friend, that because there were other people to take over the care of her husband, she was finally free to put on her pajamas, crawl into bed beside her husband and spend his last three days with him as his wife, not his caregiver. It was the first time in months that she could stop and reconnect with the love of her life.

I cried when I heard this. So often we get caught up in the caregiving that we forget that we are an important person in this individual’s life and that they are important to us. Our loved one is not a body to be turned or fed or cleaned, but the person we love.

No matter what stage you are in during the caregiving process, take a moment to remember the love when you are caregiving. You may not have forever, so do it today. Put on your pajama’s and remember why you have devoted yourself to this person. These are precious moments not to be wasted.

Have a kind and respectful day.

Lorry Schoenly, PhD, RN, CCHP, “Healthcare Behind Bars” on Sept. 28th, 1PM pacific

Lorry Schoenly, PhD, RN, CCHP, “Healthcare Behind Bars” on Sept. 28th, 1PM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Dr. Lorry Schoenly is Clinical Education Manager for one of the largest companies providing healthcare services in jails and prisons across the country. She is a registered nurse who advocates for professional nursing practice in corrections and hosts a blog site www.correctionalnurse.net . She has authored a variety of articles about nursing in jails and prisons and is a frequent speaker on correctional nursing topics at conferences and other venues.

Dr. Schoenly is also a freelance writer, editor, and instructional designer – providing consultation services on issues regarding correctional healthcare. The views, opinions and information she expresses here are her own. They are not designed to represent those of her employer or any professional or educational affiliation.

Follow her on twitter at www.twitter.com/lorryschoenly. Friend her on Facebook at www.facebook.com/lorryschoenly Catch her full bio on www.linkedin.com/in/lorryschoenly Blogging @ www.correctionalnurse.net

This week is National Invisible Chronic Illness Awareness Week – September 14-20

I think about my niece and how nobody can tell she is suffering. She has Still’s Disease and some days, she looks just fine. But that isn’t what her body is saying. Her body is screaming in terrible pain, with raging fevers and a weakness that stops her from even lifting her arms. But you might not be able to tell unless the day you see her is one of her wheelchair days. I didn’t realize how bad it could get until I traveled with her. At the beginning of the day, she will be doing okay. Then as the day wears on, the symptoms ravage her body.

She is an example of what the Invisible Chronic Illness Week is about. We can’t tell from the outside what is going on inside for people. People with chronic illnesses still go about their day and still have to live their life. They have gotten used to coping. But that doesn’t mean that they aren’t suffering. They are just doing what they have to do to take care of their kids, provide for their families and keep the household going.

We need to be tender with people. You can’t assume anything about people because you aren’t inside their body or their life. People put on a brave face because they have to, not because they want to. The next time you see someone who is being grumpy or who is slow to get out of your way, remember that they may be doing the best they can. This may be the best day they have had all year. Or maybe today is their worst. We need to choose to be compassionate, polite and understanding. There may come a day when we will need someone to be gentle with us.

Thomas Gressman, “Assistive Technology for those with Disabilities” on Sept. 24th, 9AM pacific

Thomas Gressman, “Assistive Technology for those with Disabilities” on Sept. 24th, 9AM pacific. blogtalkradio.com/kindethics

Thomas Gressman is an Assistive Technology Specialist from the Three Rivers Center for Independent Living. Thomas is part of the Assistive Technology Department. The Three Rivers Center is one of many Centers for Independent Living in the US. TRCIL is a not-for-profit organization which provides services to people with disabilities in SW PA. Assistive Technology is one of those services. AT is defined as any device, or system of devices which helps a person with a disability accomplish a task. These can be very low-tech to very high-tech.

Their goal is to help people with disabilities live independently in the community setting of their choice by providing consumer controlled supports and services. Their services include Advocacy, Assistive Technology, Waiver programs, Housing, Deaf and Hard of Hearing services, Nursing Home Transition, Peer Support, Skills Training, Personal Assistance and Transitioning. The website is www.trcil.org

Other resources include:

Harris Communications www.harriscomm.com A good starting point for assistive devices for the Deaf/Hard of Hearing.

ASL Expo www.aslexpo.com

http://en.wikipedia.org/wiki/Deaf_culture A good starting point for information on Deaf Culture
Hearing Loss Association of America http://www.hearingloss.org/

http://www.virtualcil.net/cils/ This site will direct people to a Center for Independent Living near them.

The Pennsylvania Initiative for Assistive Technology (PIAT) http://disabilities.temple.edu/programs/assistive/piat/

PIAT Assistive Technology Lending Library http://disabilities.temple.edu/news/newsletterAT/
Pennsylvania Telecommunications Device Distribution Program (TDDP) http://disabilities.temple.edu/programs/assistive/tddp/

Pennsylvania Assistive Technology Foundation (PATF) www.patf.us

Have a kind and respectful day.

When your loved one said to do everything, but everything isn’t possible

Dear Viki,

My father said he wanted everything done but I can’t bear to watch his suffering. It seems like he keeps getting these terrible treatment, but nothing works. The doctor keeps asking me if I think it is time to put him on hospice but I promised my dad that I would make sure the doctor didn’t give up on him. My dad is the type of person who would never give in or give up. I feel like I am supposed to do what he says, but isn’t there ever a time when I should just say, “Enough”?

I am so sorry you are in this difficult position. It must be so difficult trying to balance doing the right thing for your dad with trying to respect his wishes. The first thing I would suggest is to make sure you get better pain management for your dad. He shouldn’t be suffering while he fights his disease. Ask for a referral to a palliative care doctor. This type of doctor can help you with the healing of your dad’s suffering and get the symptoms under control.

Secondly, what you are experiencing is moral distress. This is when you are doing the right thing but it feels so wrong. I would be suffering like you if I was in your situation. For some people, there is tremendous value in the fight to the end. Not giving up is more important than the hardships that are faced along the way. But this can put a tremendous burden on the person having to make the decisions and to witness the results of these choices. One of the most difficult situations is when the person asks us to advocate for things we don’t agree with. The thing you have to realize is that this is your dad’s life and health. This is how autonomy works. People have the right to make bad decisions. And you have to be brave enough to do right by your dad.

The answer to your question:

Here are your obligations. Since your dad told you that he wanted to fight to the end, then that is what you should try to do. But that doesn’t mean you have to keep choosing to do things that don’t work. If the treatments are only causing suffering and are not helping your dad, then you are not obligated to continue with that plan. You are supposed to fight for the medical options that will actually benefit him. Talk to the doctor and tell him it is time for a new plan for your father. Anytime a plan stops working, we have to face it and make a new plan. If there is nothing new that the doctor can offer, then that is when you can say enough. And now your work begins as you advocate to get him the best end of life care that you can. Change the “do everything” that you have been focused on during the fighting process into a “do everything” to fight for a pain-free and peaceful death. Don’t think of this as giving up, think of this as fighting for a new goal.

Dr. Solomon Liao from the Center for Excellence on Elder Abuse and Neglect at UCI, “Recognizing the signs of abuse and taking action” on Sept. 21, 10AM pacific,

r. Solomon Liao from the Center for Excellence on Elder Abuse and Neglect at UCI, “Recognizing the signs of abuse and taking action” on Sept. 21, 10AM pacific. blogtalkradio.com/kindethics

Dr. Solomon Liao is an Associate Professor, Medicine School of Medicine and the Director of Geriatric Education at the School of Medicine University of California, Irvine. The Center of Excellence in Elder Abuse and Neglect at the UCI School of Medicine, Program in Geriatrics, funded by the Archstone Foundation.

Locally, the Center of Excellence provides medical, forensic, and victim services to abused and neglected seniors and serves as a “living laboratory” of innovative approaches.
Statewide, the Center of Excellence serves as a central source of technical assistance, best practice information, multidisciplinary training, useful research, and relevant policy issues in California.

The Center of Excellence in Elder Abuse and Neglect serves through:

Direct Services – The Center of Excellence provides medical assessments, forensic evaluations, interdisciplinary case planning, linkages with existing resources, and the identification of available and needed services in Orange County.

Technical Assistance – The Center of Excellence provides statewide technical assistance to elder abuse programs in California. Two types of technical assistance will be offered: case consultation and program development/replication assistance.

Connecting Practice and Policy – To make a sustainable improvement in the field of elder abuse, it is crucial to connect practice and policy. The Center of Excellence uses the knowledge gained through a systematic and sound evaluation process to educate those in a position to make policy decisions.

Conducting Research – Through the faculty of the UCI School of Medicine Program in Geriatrics, the Center of Excellence provides the bridge between direct service and academics. Research at the Center of Excellence is currently funded through the National Institute on Aging, National Institute on Justice, and the California Department of Health and Human Services.

Providing Education – The Center of Excellence guides the UniHealth-funded Elder Abuse Training Institute in identifying California’s most pressing training needs in elder mistreatment. Multidisciplinary experts conduct discipline-specific training seminars for law enforcement, legal, medical, and social service professionals.

To learn more about UC Irvine School of Medicine’s Program in Geriatrics and Dr. Liao’s work, please visit our Geriatric Medicine website http://www.healthcare.uci.edu/seniorhealth/geriatricmedicine/index.asp.

An healthcare insider’s look at the healthcare debate from a money point of view.

Someone recently asked me what I think about the national healthcare debate. I don’t usually talk politics but I have decided to voice my opinion and to give you a healthcare insider’s view of the issue.

Part 1:
I am very angry about the death panel comments. Finally, Medicare was going to pay doctors to spend time listening to and respecting the patient’s end-of-life wishes. (Not telling seniors what to do, but listening and respecting.) These conversations already take place, but the doctor hasn’t been able to get paid for that longer appointment time. If a plumber spends 1 hour or 5 hours at your house, they can charge you appropriately. But the doctor can’t because if there isn’t a billing code for the service, the service can’t be billed. Now the doctors will continue to not be paid to listen to your wishes while they already are sacrificing not going home to their own family on time. This will be one more reason that doctors will leave the practice of medicine. You can only mess with someone so long before they say, “I am out of here.”

The idea of a death panel goes against everything in medicine. The last thing doctors want to do is to kill people. They went into medicine to heal and save. Doctors won’t participate in making sure the prisoner doesn’t feel any pain with lethal injections because doctors won’t agree to be a participant in a death. Doctors are very opposed to physician assisted suicide, even when the patient is in out of control pain and is begging for help with dying. (About 5% of the time, pain can not be managed no matter what medication is used.) These are the types of things that politicians can’t understand. The rules of medicine are deeply embedded in the culture of medicine.

Here is what I am also angry about. The healthcare debate has become a battle of political posturing and propaganda instead of trying to come up with a really great plan. I am angry that the politicians are designing the national healthcare program. Hospitals, doctors, nurses, economic experts, healthcare and public health experts etc. should be designing the government program. It would be like an electrician trying to teach your child in school. They are not trained to do that job and are not qualified. I am also angry with the politicians because they are forgetting or are ignorant to the rules of medicine. They can’t ask the doctors to jump through these new hoops to provide adequate care and still hold them to the malpractice standards in place. You can’t tie someone’s hands and then punish them when they couldn’t do everything they wanted to do.

Here are a few other insider perspectives.

Part 2:
1. We already have 3 large government run programs: Medicare, Medicaid and the Veterans Administrations. While those aren’t perfect, they are already a form of socialized medicine. If someone is against a government run program, then I suggest they turn in their Medicare card and go buy their own insurance. The doctors are already relying on the government (Medicare and Medicaid) to pay their bills because the other insurance companies are paying the doctors less and less after they provide services. The government part of healthcare is keeping hospitals and doctors in business.

2. The biggest problem is that there are too many stakeholders involved. Your employer buys your insurance, the insurance manages your healthcare dollar while taking a big cut for themselves, the doctors and hospitals take whatever they can get and eventually you get service. You are so separated from your healthcare dollars, that you can’t understand the true cost and value of what you are getting. If you buy a Chevy or a Rolls Royce, you understand why it costs what it costs because you are writing the check. But you don’t know what you are getting or what the actual costs are when you get medical care. Would you be willing to pay for the services if it was coming directly out of your pocket?

Next, if the insurance company wasn’t taking their cut, there would be plenty of money to care for even the uninsured. And if you are paying for healthcare, you need to realize that you are already paying for the uninsured. That cost is added to part of the charges the hospitals and doctors are billing your insurance company. Removing the insurance company as a middle man would really reduce your costs.

3. Doctors are fleeing the profession. I know doctors that can’t cover the costs of staying in business. One group of Ear Nose and Throat doctors haven’t been paid a salary for 6 months. They just cover the cost of running their practice and that is it. Would you be willing to work for 6 months without a paycheck? No. But doctors are so devoted to their work that they are enduring terrible hardships. But this won’t last. They can’t do this forever. We are losing the good doctors in record number. This is not a joke. Eventually we will have to recruit foreign doctors to fill our vacancies.

4. We don’t have enough emergency rooms still open. In Los Angeles, a large number of hospitals are still open but are no longer providing emergency services. Because of EMTALA, which mandates that anybody who comes to the emergency room must be treated, it is a tremendous financial burden to these institutions. The only choice they have is to close the ER or they will have to close the hospital. There is no emergency room near me.

5. You can not expect people to keep businesses open when they are losing money. And healthcare is a business that is bankrupt. The time is now to put a new plan in place that is fiscally responsible and can meet the needs of our growing and aging population. I am not the expert but there are experts out there that should be designing this plan for us. Stop the political bickering and get down to creating a viable healthcare system.

See this article for more discussion about our role in the healthcare debate.
https://kindethics.com/2009/09/a-healthcare-insiders-view-of-the-healthcare-debate-from-a-social-point-of-view/

Have a kind and respectful day.

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 https://kindethics.com/2009/09/an-healthcare-insiders-look-at-the-healtcare-debate-from-a-money-point-of-view/

Have a kind and respectful day.

« Previous Page — Next Page »