What did the doctor say?

Dear Viki,

Sometimes when I go to the doctor, I forget what they told me to do. How can I make sure that I understand what the doctor says?

So many times we get overwhelmed by our visit to the doctors. Either they tell us too much information or they tell us information we don’t quite understand.

Here is an easy set of solutions.

1. Use the explain back method. After the doctor tells you about your disease, explain back to him what he has said. This will allow you to confirm your understanding and for him to clarify anything you got wrong.

2. When you’re the doctor or nurse gives you instructions, repeat back or explain back what they just said. Again, they will be able to make sure you got it right.

3. Ask them to write it down for you or you write it down yourself. Have them check to make sure you wrote it correctly.

4. Bring a tape recorder and record the instructions and information about your disease.

5. Bring a helpful loved one with you. A second set of ears can help you both remember the details.

6. If you have questions when you get home, call and have them explain it to you again or make a follow up appointment and talk it through again.

Yes, it shouldn’t be this hard to communicate, but it is. It is normal for people to only hear part of what is said. The explain back method is a great way to solve this problem.

Have a kind and respectful day.

Doctor Desperation = Doctors are disappearing – Part 2

I know I hold healthcare professionals to a high standard. But I also have tremendous respect and compassion for them. They have a difficult job and sometimes we make it worse for them.

I was in Las Vegas last week lecturing and there was a commercial on television. It showed two doctors caring for a patient in the hospital. The voiceover reminded the audience that if we don’t support education, then in the future there may not be enough doctors to care for and support us. And as this was said, the two doctors disappeared from the hospital room. It was a rather dramatic visual moment. What if people stop wanting to become doctors? What if it becomes so burdensome to become a doctor that the best and brightest students started going into other professions? What if it becomes so difficult to practice medicine that the doctors we already have begin to leave?

This is already happening. Doctors are leaving the practice of medicine.  How many months would you work if you weren’t getting paid?  Would you work for 1 month for free?  No, but the doctors are.  They keep working even though they can’t afford to stay in practice as the insurance companies pay less and less. The increasing use of electronic medical records is making it difficult for the older doctors who don’t type well to keep practicing. Malpractice insurance costs keep skyrocketing. And most importantly, the respect and appreciation they used to receive from patients and families is disappearing. No money, no significance, not worth it.

Medicine has always been a profound profession. Doctors knew they were making a difference and that it was worth all the years of training and the long daily hours. But now, they aren’t as sure. Just after I wrote this doctor piece, I went to give a lecture. I asked the first doctor to arrive, “What type of medicine do you practice?” He said, “I retired early. The healthcare system broke me. It became too difficult to practice anymore so I gave up.” He wasn’t an old man. He was broken man. Did he still love medicine? Of course. He was still attending a continuing medical education class. But medicine had become too difficult.

We better be careful. Our doctors are leaving us. I doubt medicine will ever pay well again, but maybe as patients, we can still let them know that our doctors are making a difference. Tell them that we appreciate and respect all of the sacrifices they make for us. Tell them that they matter.

Have a kind and respectful day.

Doctor Desperation = Corruption and Bad Deaths – Part 1

More and more I am being told that doctors are keeping patients alive against their will in order to make more money. It used to be that a doctor or two was money hungry and misusing their power to increase their income. But now this problem is spreading. I am hearing this at almost every hospital I go to and it is not just one doctor but many.  (Of course there are still great doctors out there.  Today I am talking about the problem doctors.)

Here is what is happening. Doctors get paid per activity they do. The more complicated the patient’s condition is, the more money the doctor can charge. And the best billing rate is for the ICU visit. So, patients in the ICU are being kept alive against their wishes. The doctor has control over that hospital bed and they don’t want another doctor filling it with their patient. The patient is usually unconscious at this point and the family tries to advocate for their loved one but no one is listening. I hear the family cry out, “He wouldn’t want to live like this. Why are you doing this?” But nothing happens. The nurses know what is going on but they don’t feel safe taking action against the doctor.

I understand that doctors are struggling to make ends meet like all of us. I know doctors that haven’t been paid in 6 months. They are barely making enough to pay for their office staff and their malpractice insurance. But that does not give them the right to harm patients and to go against the patient’s wishes. When a doctor goes against the patient’s stated wishes, it is called assault and battery. If you are in this situation with your loved one or are a healthcare professional witnessing this happen to your patients, tell the ethics committee and the administration. Tell anyone who will listen. And if no one will listen, contact me and I will help you.

The one thing you can all do to be safe is to write down your wishes on your advance directive so you can be protected from corrupt doctors. In my resource section, you can download a state specific document. If you need help filling it in, let me know and I will help you.

Have a kind and respectful day.

Got a question?  Ask Viki.  <!–coldform–>

Should I take away my grandfather’s car keys? – Car Keys Part 1

Dear Viki,

My grandfather is losing his memory. The other day he got in a minor accident and couldn’t tell the police where he lived or who to call. I don’t want to be the one to do it but should I take away my grandfather’s car keys?

I understand what you are going through because I had to take away my Dad’s keys a few years ago. He was getting more and more confused and forgetful. I was lucky because I took away his keys before he hurt someone or himself. But many people aren’t that lucky. Their loved one kills someone by accident and the whole family is devastated.

So the answer to your question is now. You should take away his keys today before anything worse happens. What helped me make the decision for my dad was realizing that I was protecting him from himself. I had noticed that his behavior was getting worse but I didn’t want to face it. I wanted to believe that things weren’t that bad. But they were. Not only was he in danger in the car, but he was in danger getting around the house. He kept falling and hitting his head. After three trips to the emergency department, I realized that I had to take actions to protect him. The next time he fell would be my fault so I got him a walker to help him with his balance. And I knew that if he drove again and hurt someone, it would be my fault because now that I knew there was a problem, I would be responsible. I couldn’t live with myself if someone died because I wasn’t brave enough to do the right thing.

I am not saying this will be easy. My dad hated that I took away his keys. And I had to go through the whole house to find all the copies of the keys. I realized when I found 15 copies of the keys that he had been forgetting where he kept his keys and kept getting copies made. Another solution families choose is to disable the vehicle so the person can’t start the car even if there are more keys hidden in the house. Eventually my dad got rid of his car so he didn’t have to be reminded of his loss.

And yes it will be a loss and yes they will be angry and sad. I know that someday when my niece or nephew takes away my car keys, I am going to be so disappointed. I love the privilege and freedom of driving. It will be a terrible loss but hopefully I will remember that they are protecting me and loving me. I hope they have the courage to do the right thing even when doing the right thing is difficult to do.

Part 2, Dealing with the emotions. http://tinyurl.com/qjjpb8

Have a kind and respectful day.

Got a question?  Ask Viki.  <!–coldform–>

Caregiver Burnout – You need to ask for help

I totally get what you are going through. I was a caregiver for many family members for many, many years. Sometimes I could manage just fine. But sometimes I was overwhelmed, exhausted and unappreciated.  I admire people who can take care of those who are sick or elderly or dying. But I also know it comes at a cost to the person doing the caregiving. So, let’s talk about some of the signs of caregiver stress and then discuss some ways you can ask for help. (Help is out there even if your family won’t help you.)

Signs of caregiver stress and burnout:

• Caregiver burnout is a state of physical, emotional and mental exhaustion

• Fatigue, stress, anxiety, and depression

• Accompanied by a change in attitude – from positive and caring to negative and unconcerned

Why do caregivers burnout?

• Don’t get the help they need, or if they are doing more than they are able, physically or financially

• May become ill themselves

• May feel guilty if they spend time on themselves

• May have to quit job to stay home

• May go bankrupt, both financially and emotionally

But there is another problem. By the time you need extra caregiving help, you are too tired, emotionally fatigued or depressed yourself to ask for help. You have to get a support team in place early on so you don’t have to get to your breaking point.

You may also be suffering from caregiver grief. Your loved one is not the person they used to be and you miss the way things used to be. Or the death of your loved one may be approaching and you are already grieving. This is called anticipatory grief and it is normal. There are grief support groups both online and in your community. If there are local groups you would like me to list on my resource page, let me know.

Help is on the way. There are people and organizations trained to help people in distress. The first person to ask is the patient’s primary doctor. Now you will have two possible reactions from the doctor. One may say, “I can’t help you with what is going on at home, or two, “I can order some home health support to get you through this crisis.” Now the doctor won’t be able to send in someone to take over for you, but they can order a visiting nurse, medical equipment, or someone to help.

Another person you can turn to is your local hospital’s social worker. This is a person who already knows what resources are available in your town and can give you a list of people you could call. There are also free organizations in most communities such as meals on wheels, dial a ride and volunteers with groups such as the American Cancer Society. You can also contact is your local senior center who may be able to provide services.

Have a kind and respectful day.

Got a question?  Ask Viki.  <!–coldform–>

Your Doctor’s Just Not That Into You

Do you get the sense that the doctor doesn’t seem to care about you? Does the doctor seem rushed? Are they not listening to your concerns? Do they not return your phone calls? If so, you may have a difficult doctor as your doctor.

The reality is that all doctors are rushed now. Doctors have a lot of financial pressures as the insurance companies pay them less and less every year. I know doctors that can barely pay their bills but they love medicine so they keep practicing. So, if it is just that you don’t get enough time, that might happen with any doctor.

But if it is more than that, you may have a doctor who is judgmental and won’t give you enough care. Research has shown that if a doctor doesn’t like a patient, they will spend less time with the patient. They might not like you because you are overweight, from a different religion, from a different culture, or you aren’t following their advice. Doctors get frustrated when patients won’t listen to them. You come to them for help and then you don’t take the medicine, go get your x-rays done, stop smoking, eat healthy, etc. Doctors shouldn’t get frustrated but they are human. They want you to get better and when you become a non-compliant, problem patient, then they treat you as a problem. I am not saying this is right, but this is what happens.

Your goal is to have a good working relationship with your healthcare team. And it is up to you to be a good team member too. You don’t have to agree with everything the doctor says, but you should be respectful and at least consider what the doctor is saying.

So what can you do if you have a bad relationship with your doctor? If you truly don’t like your doctor or think the doctor is the wrong doctor for you, then you should change doctors. You are allowed to fire a doctor at any time. Don’t let them tell you differently. Your insurance has to provide you other options. How do you fire a doctor? You can just tell them or you can write a letter. The doctor is obligated to give you a copy of your medical records and they are allowed to charge you a reasonable fee for this. Even if you are in the hospital, you can still fire your doctor.

One more thing to consider. Doctors are real people too. They have personal problems just like all of us. So if they are just a problem at one visit, then maybe they have just had a death in the family or are dealing with a problem teenager. Give them the benefit of the doubt and understand that they are doing the best they can. If they continue to be distracted, disrespectful or uncaring, then change doctors right away.

What nobody is telling you about your Advance Directive

For the patient and family:

The doctor just handed you an advance directive and told you to fill it out. What do you do now? Do you want a feeding tube? Do you want to be put on a ventilator? How do you answer these questions? Do you even know what these questions mean? The doctor is asking you the wrong questions. What he should really be asking is, “How do you want to live after a serious illness or injury? What kind of condition/suffering would you be willing to endure?”

The advance directive form in not just a death form, it goes into effect when you can no longer think clearly enough to make your own decisions. Now, maybe you will only be incapacitated for a short period of time and someone will need to make your medical decisions for a few weeks or maybe this will be forever. An advance directive is one way to stay in charge of your life even when you can’t speak for yourself.

So the right question is, “What kind of life would you want to live if you your mind no longer worked well or if it didn’t work at all?” Now for some people, any condition is okay as it is God’s will to determine how we live and when we die. But for others, you can’t think of anything worse than living in a nursing home, wearing diapers, having other people feed you and not being able to recognize your loved ones. But how will your doctors know what you want if you don’t tell them? Doctors know how to practice medicine. But what they don’t know is what would make for a “meaningful recovery” for you. So you have to tell them.

Here is my “Meaningful Recovery Statement”:
“I value a full life more than a long life. If I have lost the ability to interact with others and have no reasonable chance of regaining this ability; or if my suffering is intense and irreversible, even though I have no terminal illness, I do not want to have my life prolonged. I would not then ask to be subjected to surgery or to resuscitation procedures, to intensive care services, or to other life-prolonging measures, including the administration of antibiotics, blood products or artificial nutrition and hydration. I also believe that the financial and emotional burden on my family should be considered in making these types of decisions.”

Because I have written this in my advance directive the doctors will know what is important to me. Of course this doesn’t have to be your statement. Write one that is meaningful to you and attach it to or write it on your advance directive.

One more thing, please address the issue of terminal vs. non-terminal situations. If you are terminal, then it is important your doctors know where and how you would want to die. If you are only severely disabled but not going to die soon, then you need to let them know what kind of life would be tolerable for you. The best way to be protected is to write it down.

If you would like my special report on “An Insider’s Guide to Filling out the Advance Directive” and other special reports in the future, sign up for my newsletter and once a month I will send you inside information.

5 Reasons We Will Never Have National Healthcare

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.

How do I get my loved one on Hospice?

Viki,

How do I get my husband into hospice? He has cancer which has spread everywhere and his pain is not being managed. I have heard about hospice but I don’t know who to call. What can I do?

I am so glad you asked. To get a patient on hospice, a doctor has to make the referral to the local medical hospice. You have to ask your husband’s doctor, and it could be any of his doctors, to call hospice and set it up. Some doctors are not willing to put their patient on hospice because they don’t want to give up trying to save your loved one. So if your husband’s doctor won’t put him on hospice, ask another doctor you know. An ER doctor can also put someone on hospice.

After the doctor calls hospice, the hospice representative will call you later that day or the next morning. A social worker and a nurse will both be coming out to see your husband within 24 hours. They will evaluate what needs your husband has and what your family may need. If your husband qualifies for hospice, you will start receiving visits from other hospice staff, deliveries of medical supplies such as hospital beds, oxygen or bedside commodes. You will also be receiving medications to have available to take care of his pain and other symptoms. And the good news is that none of this will cost you anything.

The nurse will teach you about the new medicines and there is a 24 hour hotline you can call if his symptoms change and you need help. Every patient is different. What your husband will need may be very different that what my Dad needed. The good thing about hospice is that as patient’s health needs change, they can adapt the plan and continue to provide comfort for your loved one.

It may be overwhelming for the first few days as so many caregivers will be coming and going as they make sure your husband is well taken care of. Unfortunately, you do lose some privacy which takes some time to get used to. Don’t worry though, after a while you will get to know the hospice team and they will become your trusted friends. Most people find hospice to be a huge comfort to them as they can know that their loved one won’t be suffering.

Got a question? Ask Viki.

Unethical behavior on Grey’s Anatomy

This won’t be the first or last time I will need to comment on unethical behavior on medical shows.

I am never surprised to see unethical medical behavior on television but I worry that the general public will think that this is how medicine is done.

Grey’s Anatomy had an episode last week in which one doctor went to speak to a patient’s loved one about donating their organs to a young boy who was dying. That would never happen in a non-TV hospital because doctors are not allowed to speak to the family about organ donation.

The only person who should be talking to the family is the representative from the local organ procurement agency. This protects doctors from having a conflict of interest by having to be both the person who is trying to save the patient and the person trying to take the organs after the death.

Another unethical thing that happened was what occurred after the doctor asked the wife for her husband’s organs and the wife said “no”.

Since other organs weren’t available for the dying boy, the doctor went back and put more pressure on the wife. This wouldn’t happen either. In medicine, we are supposed to respect people’s decisions, especially when they say no. Organ donation can not be a coercive process. You can ask, but you can’t push or force people to decide to donate their organs.

To make sure your family isn’t put in this situation without knowing your wishes, make sure you tell people what you would want in that situation. If you want to donate your organs after your death, then register your wishes with your local department of motor vehicles either online or in person. If you don’t want to donate, then you should write that down in your advance healthcare directive.

I believe in organ donation because organ donation saves lives. Maybe someday it will save yours.

Got a question? Ask Viki.

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