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.

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.

Why did they take my son’s body away so soon?

Dear Viki,

My son recently died at home with the help of hospice. They were great but I am still really angry that I didn’t know they would take my son’s body away so quickly. When the funeral people showed up, they took him away before I was done saying goodbye. Shouldn’t they know that isn’t right?

I am so sorry that was your experience. And I am sorry for your loss.

Here is what someone should have told you. When you call the funeral home for them to pick up your loved one, they come out within an hour or so. If you had wanted longer with your son, then you should have delayed calling the funeral home. But of course you didn’t know this and nobody explained it to you. Delaying calling them would have given you a little extra time for you to finish saying your goodbyes. You can’t delay calling them for days, but it is okay for a few extra minutes. (If you are anticipating a death in your family, you should ask the mortuary how long it usually takes to pick up someone who has died.) Once they arrive, they should be respectful and compassionate and give you a few more minutes, but they can’t wait for hours once they arrive.

Have a kind and respectful day.

Jumping to the Wrong Conclusions

On Grey’s Anatomy the other night, there was a family of three siblings waiting for their mother’s death. They seemed rather inconvenienced and one kept asking, “How soon will she die because I have a plane to catch?” At first the characters and the audience all thought, “How insensitive, how uncaring.” But as the scene and story progressed, the audience realized that we had jumped to conclusions. This was a devoted family that been flying in every time their loved one was at death’s door for a few years. And they had said their goodbyes and grieved, over and over again. They weren’t insensitive, they were exhausted. And at this point they thought they were just going through the motions one more time and she would recover. One sibling even said, “We love her and want to be with her when she dies.” And when the woman did die, the three siblings, sat down with her, cried and asked if they could spend more time with her before the body was taken away.

In watching this, I am reminded how easily we jump to conclusions about other people. We judge them before learning more about the situation. We assume the worst. I have been guilty of expecting the worst out of someone. I have learned to give people the benefit of the doubt. When I encounter someone who is being difficult or uncaring or rude, I remember that I don’t know what just happened in their life. Maybe they just found out that they have cancer or they just found out their spouse has filed for divorce. We just don’t know. So I ask, “Is there anything I can do to help? Is there anything I need to understand?”

I have also been guilty of being the overwhelmed caregiver who starts to care a little less. I hope that the nurses understood that caregiving is a long journey. And that when I visited my aunt, and could only bear to stay a few minutes instead of my usual longer visit, that they didn’t judge me but were compassionate. I hope they didn’t whisper behind my back. But, I don’t know. As healthcare professionals, we have to start from compassion and work from there.

Don’t Tell Grandmother She Has Cancer

 

Dear Viki,

The other day, I had a family tell me to not tell their grandmother that she had cancer and was going to die soon. I am not sure what to do. I want to be culturally respectful but I also have to make sure that I am doing right by the patient. It is her life, not the families. What should I do?

Great question. If it was 40 years ago, a doctor could keep information from a patient. Now the rules are different. Here is what you need to do to respect the patient and the culture.

1. Speak directly to the grandmother, hopefully without her family in the room. Ask her, “Do you want the results from the tests we are doing or should I be talking to somebody else? Do you want to make your own decisions or would you prefer that someone else make those decisions for you?”

2. If she says, “Yes, I want to know the results and make my own decisions”, then you will know what to do. Tell her the information. You may also want to check with her if she would prefer to have these conversations in private or with her family present. Sometimes it is just as important to the patient to protect their loved ones as well. Respect the patient’s wishes while you show respect for this family’s culture.

If she says, “No, I would rather focus on getting better and let someone else deal with all of the decisions”, you also know what to do. You now must ask her, “Who should I talk to?” Once she tells you who is in charge, and it might be a 2-3 people, then talk to them. This is called a waiver of informed consent. Patients can act autonomously and waive their right to information. You may want to have her to fill out an advance directive or living will ahead of time and check the box on the form that says, “Starting now, I want _____ to make my decisions for me even though I still have capacity.” If she changes her mind later on, then you can follow her new instructions and begin having her give her own informed consent.

Have a kind and respectful day.

 

How to help your patient understand what you have told them.

The conversation with the patient should be a dialogue, not a monologue. But we are in a hurry and forget to make sure they understand us.

Here a few easy solutions:

1. Use the explain back method. After you tell the patient about their disease, have them explain back to you what they heard you say. This will allow you to confirm that they have understood correctly and it will allow you to clarify anything they got wrong.

2. Same thing when you give them instructions. Have them repeat back what they heard you say. Again, you will be able to make sure they got it right. If they got it wrong, just repeat the instructions again and then have they explain back what they just heard.

3. If this isn’t working, then you will need to write down the instructions for them or have them write the information themselves. Ask them which they would prefer, you writing or them writing.

4. Have them bring a tape recorder and record the instructions and information about their disease.

5. Have them bring a helpful loved one with them. A second set of ears can help them both remember the details.

6. Tell them that if they have questions when they get home, have them call back and your nurse will explain it to them again or they can make a follow up appointment and go over it with you again.

Yes, it shouldn’t be this hard to communicate, but it is. It is normal for people to only hear part of what we say. 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.

Blog Updates: Newsletter, Interviews, Resource Pages, Listen Feature

I just completed this month’s newsletter.  The feature article is “Communicating with the dying.”  To get a copy, sign up on the lower side of the blog and I will send it out to you.   If you want to get blog updates, notices about new blogs being posted, sign up on the upper side of the blog.  They are separate services.  You are welcome to both.

I feel very fortunate to be able to include a thank you I just received from Elizabeth P in New Jersey.  “Viki helped me in my crisis. There was no wait, no down time, and she knew her stuff!”

She called for help a month ago and just wrote back to tell me that things worked out well.  I was so glad I was able to help.  She was in a medical crisis with her mom and the doctor was not listening and was going against her mother’s wishes.  I told her what steps she needed to take and gave her insight into how to communicate best with the physician. I wish Elizabeth and her mom the best.

There are more Blog Talk Radio interviews scheduled.  They are listed on the side panel.  To hear the show, you can listen live through http://blogtalkradio.com/KindEthics, or you can listen on the phone at 347-945-5152.

You can also use 347-945-5152 to call in to ask questions live.  If you want to listen later, then you can listen through the computer, just click on the link on my site, or download it through itunes.

If you know someone who is doing amazing work that I should be interviewing, please have them contact me.

I was happy to hear that people in Indiana and Maryland used my resource page to get their state-appropriate advance directive.  I just hope they will fill them out.  (smiling)  If anyone needs help with this, email me viki@kindethics.com

I also added a California POLST section to the resource page.  POLST stands for Physician Orders for Life Sustaining Treatment.

Lastly, my great blog strategist and social networking expert, Michelle Price, AThirdMind.com, just installed the listen to the blog feature.  Now you can press listen and while you are doing your housework of playing with your cat, you can listen to the updates.  You can also go through and download them.  I wanted to make sure that this website is accessible to all those with types of needs.

Have a kind and respectful day.