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.

Ombudsman Program cut dramatically in California. With these cuts, you need to be more proactive about protecting your loved ones in nursing homes.

I don’t know if you know about a service that is provided free of charge to our nursing home residents. It is something called an ombudsman. (I have used the services of the Ventura County Ombudsman program when my aunt was in a nursing home.) The ombudsman is a specially trained person who protects the resident from being forced to sign something they don’t understand, protects them from elder abuse and protects them when they are receiving sub-standard care. I will be interviewing Molly Davies from the Los Angeles County Ombudsman Program, The WISE & Healthy Aging Long-Term Care Ombudsman Program, in August but I just wanted to let people in the Los Angeles area know about the effects of the budget cuts today. The office is down to 10 people who are protecting the 73,000 nursing home residents in Los Angeles County nursing homes. If you have a loved one in a nursing home in California, you need to be even more diligent about visiting and checking on your loved ones for the rest of this year. Hopefully, next years budget will better but for now, we all have to take on the role of the protector for our loved ones. Here is the statement from the Los Angeles County office.

Long-Term Care Ombudsman Program
Impact of the Governor’s Budget Reduction

The impact of the enacted 49% State budget cut to the local Long-Term Care Ombudsman Program (LTCOP) in California is devastating to the integrity of the services that are delivered and will negatively impact the residents that we serve. The WISE & Healthy Aging Long-Term Care Ombudsman Program is the sole contractor of Ombudsman Services in the City and the County of Los Angeles. The impact to this local program has been the loss of $1,109,783 in funding retroactive to July 1, 2008. In response we have eliminated 22 positions resulting in the reduction of staff from 32 to 10, and we have closed our Lancaster, Downtown LA, Burbank, and San Dimas regional offices. All remaining staff received a reduction in salary.

The following are conservative projected estimates of the reduction of our capability to deliver service to residents in long-term care.

Over 12,000 unannounced visits to nursing homes and board and care or assisted living facilities will not be conducted during this fiscal year, and every year thereafter.

Over 11,500 cases, including allegations of abuse and neglect will not be investigated during this fiscal year, and every year thereafter.

The LTCOP in California has three currently unfunded mandates that include the investigation of elder and dependant adult abuse investigations that occur in long-term care settings; the witnessing of advance health care directives for residents in skilled nursing facilities; and responding to the 24-hour State Ombudsman after-hours crisis line. Although these are unfunded mandates, we have managed to take on these tasks with out further compensation from the State of California, but may not be able to sustain these activities without restoration of our funding.

In the last fiscal year the WISE & Healthy Aging Ombudsman Program responded to 2,086 abuse complaints. Many elder abuse cases are identified during unannounced visits conducted by Ombudsmen, which will decrease proportionally with these enacted budget cuts.

The WISE & Healthy Aging Long-Term Care Ombudsman Program is the largest in the nation providing service to more than 1,816 facilities that have the capacity to care for 73,486 residents. The Ombudsman Program advocates for the rights of residents in long-term care facilities, and for many residents we are the only outside support they receive. The impact of these cuts effectively silences the voices of our most vulnerable constituents, residents in long-term care.

You may want to support the pending legislation AB 394 (Feuer and Jones) Protecting Vulnerable Seniors from Abuse and Neglect by Restoring Ombudsman Funding
AB 392 would use penalties paid by substandard nursing homes to help restore monitoring and advocacy by ombudsman programs. It is fitting that the penalty funds be used to support the ombudsman programs given their critical role in protecting residents’ health and safety.
Current law allows the penalty funds to be appropriated for ombudsman services. AB 392 would require that at least half of the penalty funds be allocated to local ombudsman programs each year in accordance with an existing formula.
Support AB 392 is co-sponsored by CANHR and the following organizations: AARP, Bet Tzedek Legal Services, California Alliance for Retired Americans, California Association of Area Agencies on Aging, California Senior Legislature, California Commission on Aging, Catholic Charities of California, Congress of California Seniors, and Ombudsman & HICAP Services of Northern California. Additionally, it is supported by local ombudsman programs and many other consumer organizations.

You may want to write or call your state senators.

Want More Information?
Use www.leginfo.ca.gov to find contact information for your Senator • and Assembly Member
and to keep track of AB 392’s progress.
• Visit CANHR’s website (www.canhr.org) for updates on all of CANHR’s legislation and to find
out how to become a CANHR Advocate.
• Call CANHR @ (800) 474-1116.

Have a kind and respectful day.

When you can’t understand your doctor’s accent, you may be in trouble.

As our country becomes more and more diverse, the issue of language and communication becomes an ever growing problem in healthcare. There are 329 languages being spoken in America, and with that comes many different accents. If you can’t understand your doctor, you may be in trouble. If you can’t hear the instructions for your surgery, how to take your medications or the information they are telling you about your disease, then how will you be able to get better? This is not about bias, this is about your safety and reality. And I’m not just talking about accents from other countries; it may be accents from different parts of the country. And if you add the increasing hearing loss with our aging population, it only compounds the problem.

So what can you do? If you have a choice, pick a doctor that speaks the same language that you do. The other good thing about picking a doctor who speaks your language and is from the same culture is that when it’s time to make end-of-life decisions, you will probably be in greater agreement. If you truly can’t get a doctor that you can understand, then ask for a professional medical interpreter, even if you are both speaking English. You are entitled by law to have a professional interpreter in a hospital. There is also a medical service that that is free called the A T and T interpreter phone line. You can get an interpreter on the phone and they can help you with your conversation with the doctor.

I was talking to a professional medical interpreter at Children’s Hospital and she was telling me about the different ways one gets into trouble when using the family as the interpreter. She told me that in one language, the words a doctor might say when a patient has died, “I am so sorry your sister has died” don’t translate very well. “I’m sorry” in that language means, “I’m responsible. I killed your sister.” Oops. If you had a professional translator in that situation, the interpreter could have stopped and asked, “Is that what you meant to say?” And of course when the doctor said no, she could then help put the words into terms that would be acceptable. The translator in this instance would say that what should be said is, “I’m so sad. Your sister has died.”

This is just one reason you should be using a professional translator. There are other reasons as well. Your family may not be able to translate some of the terminology because they’re medically illiterate. The language of medicine is complicated. Or they may have an agenda and only translate some of the information to you, the patient. Or they may be following their cultural rules about what can be spoken to their elder. Or there may not be a word for what the doctor is trying to say in your language. Did you know that in one language there is not a separate word for bacteria and virus? There is only one word to describe both. How is your doctor going to explain something when they don’t even have a word for it? Good luck without a professional interpreter.

If you do use an interpreter, make sure you thank the interpreter and respect that they are professionals and are there to help us. Using an interpreter may save your life.

Lastly, your local hospital may want to consider having the interpreters visit the patients throughout the day to make sure their needs are getting met and that they feel like they have a voice in their health care. Your hospital may also think about sending interpreters into the doctor’s offices to provide interpretation services in the outpatient setting. Some hospital systems in Los Angeles have already begun doing this and it is making a difference.

Have a kind and respectful day.

Taking The Car Keys Away Part 2 – Dealing with the Emotions

I have been surprised by how many people have contacted me about the issue of taking the car keys away from a loved one. What I want to add to the discussion is that we have to remember to address the emotional issues being experienced by the person losing their driving privileges. They should be angry. They should be sad. These are normal emotions as they come to terms with not only the loss of driving but the loss of their mental and physical abilities. It is a good idea to sit with them and let them speak their mind. All you have to do is listen. Don’t defend yourself. Don’t defend the doctor. Just listen. As you hear their words, think about the day when you will lose your driving privileges and find compassion for your loved one.

One technique you can use is something called active listening. With active listening, what you do is to repeat back the words and the emotions you are hearing. For example, when your mom says, “I am so mad at you for telling the doctor that I shouldn’t be driving anymore.” What you can say is, “I understand that you’re really mad at me mom and that you wish I hadn’t told the doctor.” Your natural instinct is to defend yourself or to explain the reasons you did what you did. This conversation is not about facts, it is about emotions. Just hear your mom’s heart and allow her to experience her feelings. It will probably take a while as you listen and acknowledge her feelings. As she feels heard, she will calm down. And it may take a number of conversations so don’t be upset about this. Don’t you sometimes have to vent more than once about something you are dealing with in your life? Just accept that this is part of her healing process. Hopefully over time, she will come to terms with this loss and move on in her life. But don’t expect her to be happy about losing her ability to drive. It will always be a disappointment.

Lastly, I encourage you to take a look at the first part of the HBO Alzheimer’s special found online at http://www.hbo.com/alzheimers/. It is called, “The Memory Loss Tapes” episode. About halfway through this first section, a woman whose doctor has recommended she stopped driving is put through a driving evaluation test. It is shocking to see how bad it has gotten and that to realize that she just recently lost her privileges. This woman has been a danger on the road for a long time. Please take action sooner than later and save lives.

Part 1, When should I take away the car keys? http://tinyurl.com/c9zjqp

Have a kind and respectful day

When you are standing alone in the hospital waiting room and don’t know what to do next, you can call me.

I remember when my mom was dying and I was sitting vigil with her in the hospital on the last day of her life. My brother, who I was close to, said to me, “There really ought to be someone who can help people with this.” And what he meant by “this”, it was the dying process. I said to him, “This is what I do, I am a hospice volunteer.” My brother knew me very well and knew that I worked with the dying, but he couldn’t imagine what that meant. And if he couldn’t imagine what a hospice worker does, then a lot of people may be confused or unsure.

But it is not just hospice that people have questions about. There are so many new things to deal with when a loved one is sick. There are specialists who can help you make your home safer for the patient, help you with applying for disability benefits or help you make decisions about both the short and long term plans.

I get called by so many people, whether it is for help during the dying process, help with figuring out what to decide when the patient can’t speak for themselves anymore or how to deal with a conflict in the hospital. You aren’t alone. I can help you when you are standing in the hospital waiting room asking yourself, “Am I doing the right thing? What do I do next?” You can run it by me and I will walk you through it.

Have a kind and respectful day.

A Life Lesson from Aunt Berda – Coping with a Chronic Illness

My Aunt Berda was diagnosed with Multiple Sclerosis when she was 31. She was amazing as she didn’t even use a wheelchair until her late 70’s. I asked her about her symptoms one day and she explained to me that she had constant numbness and tingling. I was shocked. If you met my aunt, you would think that she didn’t have any physical suffering with her MS. But she did. I asked her about how she handled the symptoms while keeping her good nature. Here is what she told me.

She said that when she was first diagnosed as a young woman, she spent 30 days in the hospital paralyzed. She made a decision at that time that if she had to be a patient, then she would be a good-natured patient. She didn’t need to make life miserable for those who were caring for her. She said that every day she wakes up and “Chooses to be happy.” That it is an active choice. Maybe two days a year, the symptoms got the best of her but most of the time she kept to this decision. Did the MS affect her? Of course, but she kept her good nature and chose to give to others everyday. She was a wonderful listener and provided a supportive ear to all that interacted with her. I knew she was special but I was still surprised when a nursing assistant said to me, “Look at this.” I looked at the cell phone she held out to me and a picture of my aunt and this caregiver was the main picture on the phone. This caregiver said that my aunt was her best friend. And I didn’t even know about it. It was a powerful lesson in knowing that no matter what the circumstances we find ourselves in, we have a choice. We can choose to make a difference. We can choose to be happy. My aunt died last year but her lesson lives on.

Choose to have a kind and respectful day.

Choosing the “Least Worst Option”

Sometimes we have to choose between, not a good option and a bad option, but between two terrible options. I have been in this situation before when making decisions for my dad with his worsening dementia, and what helped me was something I read. Sometimes we have to pick the “least worst option.” What does this mean? It means you don’t have a good answer or a good choice. All you can do is to pick the least terrible option. Because that is your best option. I know this is terrible, but sometimes we have to make peace with this dilemma. Of course, we first have to work very hard to figure out if there are other better options available and ask other people for help. But sometimes it comes down to a decision that will never feel right or good. Just do the best you can and pick the least worst choice.

Have a kind and respectful day.

Doctors could get paid to listen to patients about their end of life wishes. Help is on the way with H.R. 1898 being proposed in the House.

H.R. 1898 is being proposed in the United States House of Represented. What this bill does is to provide financial support for doctors to have meaningful end of life conversations. This is amazing. Right now, doctors get paid to take action. Now they could get paid to stop and spend time talking to patients and families about important end of life decisions. And I will tell you, doctors do what they get paid to do. If they get paid to go to surgery instead of allowing physical therapy to work, then they will go to surgery. This proposed legislation is historic. Being paid to listen and respect the patient’s wishes while designing an appropriate end of life care plan would be great. This is a great beginning to shifting the culture of medicine by changing what priorities will be paid for by Medicare.

Wash Your Hands or Use Hand Sanitizer – And make sure the medical professionals who are touching you are doing the same

I just finished reading, Complications: A surgeon’s notes on an imperfect science by Atul Gawande. A fascinating read into the world of surgery and the recovery process. In this time of swine flu, he brings up an important point. Wash Your Hands or Use Hand Sanitizer. And more importantly, make sure your doctor and all the people who are touching you in while you are in the hospital, wash their hands or use hand sanitizer. It was interesting to read about how diligent surgeons are in the operating room about keeping you safe from germs. But when they visit you in your hospital room, they are less cautious and sometimes forget to wash. And it is not just surgeons, it is everyone in hospitals. I think what I might do the next time I am a patient in the hospital or visiting someone in the hospital, is to make sure I bring in a large bottle of hand sanitizer to keep by the patient’s bed. That way, the patient can take charge and make sure that everyone that touches them has cleaned their hands. And that also includes the visitors. I hope that a long term side effect of the swine flu scare is that people keep washing their hands even after the scare is over. It is one powerful thing we can do to protect ourselves and the people we love throughout our lives.

Have a kind and respectful day.

A New Trend – Vigiling Services

Unfortunately, many patients are going to end up dying alone in the hospital, either because the rest of their family has died first or they are private people without any friends or family. I don’t know if you have heard of this but hospices across the country are providing a wonderful service. It is called vigiling. The hospice sends volunteers over to their local hospitals to sit with the patient who is dying alone. As much as nurses try very hard to be present for the dying, they have many patients to care for and can’t stay just in one room. So the volunteers sit in shifts and stay with the person until they die. Of course, these volunteers are highly trained and work cooperatively with the doctors and nurses. How wonderful. This patient has someone present in case they need help as they die and they do not have to feel lonely and afraid.

Now people who work with the dying would say that people live as they die. So if you have been a mean and hurtful person, then you may die alone. Or if you have lived a social life with lots of friends, then you will die surrounded by friends. Your death depends on your life.

No matter what, vigiling is still a good thing to do. People should not have to die in fear or in pain. We don’t know what brought this person to this moment in their life because we don’t know their story. And they are probably too ill to tell us about their life’s journey. Ultimately, we should show compassion and give our patients comfort as they die.

Have a kind and respectful day.

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