A Timeline Tool For When You Are In The Emergency Room

Dear Viki,

I got a call from someone as her grandmother was being taken to the hospital. Her grandmother’s doctor wouldn’t come to the hospital even though her mom had chest pain and very high blood pressure. After asking more questions, I explained to her that the probable reason the doctor wouldn’t come to the hospital was that he didn’t want to interrupt his weekend plans. I know it is cruel to say, but it is probably true. I know there are lots of great doctors out there but you have to realize that I only get called when there is a problem. (Now before the doctors reading this get angry, the person had a blood pressure of 240 over 110, chest pain, vomiting and the doctor said to not take her to the hospital. And the doctor was on call that weekend.) I also know that doctors are real people and they hate being on call on a holiday weekend. I don’t blame them. How would you like to have your day interrupted and have to leave in the middle of your most precious family events? This is one of the sacrifices they make for us.

So back to the story:

I talked the person through what to say to the ER doctors to make sure they got what they needed. I explained how to get the services she needs by using respect and good communication. You have to make it easy for the doctor because time is limited. You need to organize what you are going to say, be clear and give both the current facts as well as the past medical history. Here is where you have to be careful. You have to focus on telling them what is relevant to this situation. My dad would go to the doctor for a pain in his leg and then spend his time talking about his dysentery from World War 2. It was not the same body part and it was 60 years ago. Yes, you should give information about the person’s medical past but try to make sure it is relevant to the situation. But you may not know what is relevant so instead you can create a timeline for the doctor. (Keep a copy with you and with the patient for emergencies.)

One way you can do this is to construct a written timeline of the patient’s health. Here is an example:

1945: dysentery during the war
1988: cataracts diagnosed
1998: double bypass surgery
1999: cataract surgery
2001: prostate surgery for enlarged prostate
2002: allergic reaction to sulfa drugs
Include a list of medications and allergies

Now the doctor can see all the important events and he can get to the information quickly and effectively. Then you can spend more time talking about the present situation. The more you help the doctor whether it is in the office or in the hospital, the more they can help you.

Have a kind and respectful day. Viki Kind at KindEthics.com

Why isn’t the insurance company paying my bill?

Dear Viki,

I just got a bill from the hospital, but I don’t think it is right. It says I owe money but I have insurance. Why isn’t the insurance company paying my bill? What do I do next?

There are so many reasons your insurance isn’t paying the bill. And I know that it can get overwhelming as you receive bills from different offices, different doctors, different labs and from people you’ve never even heard of. Instead of getting frustrated, ask for help. If the person you’re working with is not helping you, ask for someone else in the department. Unfortunately many people who work in medical billing are often under trained, underpaid and overwhelmed. So it may take talking to many different people to get the help you need. For me the first thing I do is to take all the bills and organize them by date of service. Then I can match what was done to me with the bills I have in front of me. And then I begin following the instructions I have listed below.

Let’s start from the beginning of the story and find out what might have gone wrong.

1. When you went into the doctor’s office or hospital, did you give them your correct insurance information? Not the old card, but the newly updated card?
2. Do they have the right address for your insurance company?
3. Have you been paying your insurance premium so your insurance is still in place?
4. If you have two insurances, did you tell them which insurance is primary, so they billed the right insurance first? Do you know which insurance is your primary insurance?
5. Did the office or hospital ever send the insurance company the bill? Surprisingly, the billing staff does not always do their job so sometimes the reason the insurance doesn’t pay the bill, is because they never got the bill. Call your insurance directly and ask if they have a copy of the bill and if so, why they didn’t pay it? If they don’t have the bill, ask them for a direct name and fax number that the bill where the bill can be sent. Then give this information to the doctors or hospital’s billing department and then follow up with them in one week.
6. Now let’s talk about the referral/authorization process. For many people’s insurance, you have to have a referral before you see certain doctors or receive certain tests or procedures. Or if you are in the emergency room, have someone in your family call your insurance right away and get the authorization for you to be in the emergency room. Did you get that referral? Did the office staff call for your referral? Did you call the insurance company to make sure the referral was done before your surgery? And did you make sure that all of the doctors that would be working on you during your surgery are covered under your insurance plan? If you don’t get the referral, you may be responsible for the entire bill and you definitely don’t want this. Never assume that it is all taken care of. Make sure you call the insurance company and get the referral number yourself. They should also send you a piece of paper that tells you that you have been okayed to have the test or surgery or see the specialist that your doctor recommended. You have to be an active participant if you want the bills to get paid.
7. Maybe your doctor’s office did everything right, had the right insurance card, got the referral ahead of time, billed the right insurance but still there is no payment. Now it is time for you to get on the phone and ask the insurance company what the problem is and why there is a delay in sending out the payment. You may also want to go to the doctor’s office and have the billing person call the insurance company while you wait. That way, if there is a question, you can be there to help and to make sure it got done.
8. Now many doctors offices use outside billing departments and the person you need to talk to will only be available by phone. This is when you have to hold your temper. I know you are frustrated but if you yell at them they won’t help you and you’re going to get stuck with the bill. So calmly, talk to the billing person and find out what they think is going on. You can offer to call the insurance company yourself to help them solve this problem. Since you want them to be on your side, remember that they will be more willing to help a polite person than a screamer. Thank them for all of their effort even if the problem isn’t completely solved because you will probably be working with them again when they mess up your bill the next time.
9. Many times, the bill itself was not created correctly. There are codes and details that must be typed in and sometimes these are typed in incorrectly for whatever reason. This is when you need to ask for a billing manager to help you check that the codes that were used were the right codes and that the details on the form match your insurance and personal information. It may be as simple as your insurance number was typed in incorrectly or it was sent to the wrong address.
10. After you do everything you can to get the correct bill to the correct department of the insurance they still may not pay your bill. If they won’t pay the bill you can appeal their decision. You will need to ask the insurance company how to appeal their decision and what you will need to do to provide the information they will need to change their minds. Sometimes, the doctor needs to send more documentation or a different code needs to be used. Even after the appeal, you may still be responsible for this bill. The worst thing that happens is when you didn’t get the appropriate referral and now it is too late. This is why getting the referral is crucial before you go to specialist, go to the emergency room, have the procedure or have the surgery.
11. I want to caution you to not get frustrated and to stop working on this situation. The doctor’s office will eventually send you to collections and the collection agency will eventually report your delinquent bill on your credit report. Then you are in worse trouble. The collection agency knows even less about getting the insurance company to pay and they are not particularly interested in helping you, just getting the money from you. And they will sue you. This is when you have to take immediate action before the collection agency takes action against you. Call the insurance company for help and go back through the steps above. The doctor’s office will not help you at this point as they have referred you to collections. You can try begging the doctor to take your bill out of collections but that rarely works. The doctor’s office or hospital has already tried to get you to pay for months and are frustrated with you. Please try to take care of this problem before it gets to this point. If it gets to this point, it may be too late now and you may be stuck paying this bill.

If you really do owe the money after the insurance paid their part:

Now your insurance paid, but now the doctor is asking you for money that you don’t think you owe. There can be lots of confusion. You may be right or you may be wrong. The first thing you want to look at is something called the EOB or the explanation of benefits. This is the form the insurance company sends the doctor and hopefully you, which explains why they paid what they paid and who was responsible for the balance. When you look at the explanation of benefits you are looking for the word’s “patient portion” to figure out how much you owe. This is another place where the billing department may make mistakes. They may forget to do the write off that is required by the insurance contract with the doctor’s office. And they may be billing you for the wrong amount.

You may also be the problem. You may not understand what your policy requires and what your portion of the bill should be. Before you get really angry, call the insurance and have them talk you through it. If the doctor’s office is wrong, ask them to make the corrections and to let you know when it’s accomplished. Put it on your calendar to call them in a week to make sure it really got done. You don’t want a surprise letter from a collection agency in your mailbox.

If you do owe the bill, whether it’s to a doctor’s office or a hospital, if you call right away they may be willing to set up a payment plan. The longer you delay, the less likely they will be to work with you. They may also have a special program set aside for people who cannot pay their bills. Again, it is better to communicate directly and work with them to solve these issues. The billing department may also be able to help you sign up for services such as MediCal or MediCaid.

Create a caregiver manual to help you train your next caregiver.

Dear Viki,

I have to hire a new caregiver for my dad. I get so tired of having to take time off of work to train the new person. Is there anything I can do to make this easier?

Yes, I recommend creating a caregiver manual just like you might have an employee manual at work. The way to do this is when you are training this new caregiver, write down everything you are telling the new person. Write down things like how your dad likes his sandwich made or what time he takes his naps. Create categories such as food preferences, activity preferences, clothing preferences, schedule preferences, medications, allergies, emergency numbers etc. Whether you write it down in a notebook or on the computer, keep adding to it as you train the person. Then give the new caregiver a copy so they can refer back to it. You can also ask the caregiver to write notes in it as things change or as she/he learns new things about your dad. This way, the next time you have to hire a caregiver, you have a head start. You can give the training manual to the new person to read before they start and they can use it as a reference for those first days when you leave them on their own. This doesn’t mean you won’t have to train them. You just won’t have to make yourself crazy trying to remember if you have gone over everything with them and you won’t forget to mention something important. (Keep an extra copy in a safe place. You don’t want a disgruntled employee to take off with your only copy.)

Have a kind and respectful day.

“Changing your Nursing Home Culture and Environment.” Part 2 of Interview with Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” on July 31st, 12pm PST.

Changing your Nursing Home Culture and Environment.” Part 2 of Interview with Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” on July 31st, 12pm PST.

Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics. To listen to Part 1: http://tinyurl.com/rdsf58

An award-winning writer, consultant, and former school principal, Frances shares insights and experiences about her years of hospice volunteering in Detroit nursing homes. Using stories, poems, and general information, she has written a groundbreaking book that is an inclusive and literal guide for becoming dead the right way. Topics include hospice, caregiving, dementia, death, bereavement, and strategies for improving eldercare and nursing homes. While universal perspectives are presented, the often missing views of people of color and residents in urban nursing homes are examined.

Frances’ background as an educator and her upbringing in New Orleans, LA add interesting layers to her problem solving in nursing homes and to her descriptive storytelling. She uses her writing and public speaking skills to advocate for senior citizens and promote conversations empowering others to have dignified death journeys. Her favorite anonymous quote is “If you think one person can’t make a difference, you haven’t been to bed with a mosquito.” Visit Frances in cyberspace at www.francesshaniparker.com and at her blog titled “Hospice and Nursing Homes http://hospiceandnursinghomes.blogspot.com

Video Poem: Reflections of a Hospice Volunteer (Hospice, Nursing Homes, Eldercare) 3:25 mins.

http://www.youtube.com/watch?v=LeBl5QtlPxg

Video Poem: “Pieces of Our Minds” (Dementia, Alzheimer’s Disease, Hospice, Nursing Homes) 2:24 mins.

http://www.youtube.com/watch?v=LgRoKDUEOUk

(Search under FrancesShaniParker on youtube.com.)

Have a kind and respectful day.

When you hear the words, “There is nothing more we can do.”

As a patient, there may come a time where you hear the words, “I’m sorry, there’s nothing more we can do.” I want to apologize for the doctor’s abrupt words. Many doctors have had little training in having these types of conversations and are incredibly uncomfortable. What your doctor should really be saying is, “Even though there is nothing more we can do to cure you, there’s lots more I can do. I can do plenty to keep you or your loved one comfortable, out of pain, minimize your suffering, refer them to hospice, get your religious leader in here to pray and help provide a peaceful and dignified death.” Just because you don’t hear this doesn’t mean you shouldn’t ask for this. You should advocate that the doctor makes sure you get what you need as your disease progresses and as you die. Help the doctor help you by asking for a palliative care referral if you are having problems with pain. Ask for a referral to hospice when the patient is sleeping more and eating less. You want to stay connected to the doctor even if the direction of treatment has turned to comfort and care.

As a patient or a loved one, you will have a strong grief reaction to these words. You may be in denial, in disbelief, in numbness or feel some other strong emotions. If you are in denial, you will not believe that what you were just told is true. This is okay as it is the way your brain protects you from bad news. Eventually, you will hopefully come out of denial so you can use your remaining days wisely. Or you may find yourself in disbelief. Disbelief is where you keep saying to yourself, “I know the doctor just said ______ but I can’t believe it’s true.” In this situation, you may want 2nd opinions or repeated tests. This is disbelief. Your brain knows it’s true but it is not ready to accept this news. This is also okay and normal. Or you may be numb. This can really be a problem when the doctors want you to make decisions. Ask for a few days so you can process what you have been told before you make these final decisions. You may also have many other types of emotions: anger, fear, hopelessness, helplessness, sadness, etc. These are also normal as you come to terms with your life’s expiration date.

You get to choose how you want to spend your remaining days, months or years. Choose carefully as you won’t get these days back. And if you are like someone I knew who was waiting until they got closer to death to write love letters to his children and his wife, realize that sometimes when get closer to death, you may not have the energy or strength left to finish your goals. Please use your time wisely.

Have a kind and respectful day.

When you have to say, “There is nothing more we can do”, there’s a better way to do it.

Unfortunately, there comes a time in a patient’s life where you have to say to the patient or their family, “I’m sorry, there’s nothing more we can do.” This is the wrong thing to say and let me explain why. I know what you’re trying to say is, “there is nothing more we can do to cure your disease” but what the patient or loved one hears is, “I’m giving up and walking out this door and never coming back.” I know that’s irrational and that’s not what you meant to say but unfortunately these words sound like abandonment to the patient or family.

I believe it’s important to tell the truth about prognosis (if the patient wants to hear it), even if you can’t give them an exact time give them an estimate. You can say days to weeks, weeks to months, months to years. People deserve the opportunity and time to clean up their lives. So, when you have to say that there really is nothing more you can do, you may be missing a really important piece to this conversation. Here is how to solve this. Go ahead and tell them that there’s nothing more you can do to cure the disease, and then continue on and say, “But there’s lots more I can do. I can do plenty to keep your loved one comfortable, out of pain, minimize their suffering, refer them to hospice, get your religious leader in here to pray and help provide a peaceful and dignified death.” Helping someone to have a pain-free and dignified death is substantial. I don’t know if you realize this but palliative care specialists have the highest satisfaction rate of all medical specialties. And why is this? It’s because this is profound and meaningful work. You really matter to the patient and the family on those last days of life. It is wonderful if you can say to the patient that you’re going to walk on this journey with them no matter where it takes you. Then they won’t feel abandoned and alone. You will still be the healer, but now the focus of your healing is to heal suffering, not the disease.

The other reason this technique works is because whenever you have to say no to a patient, it is always important to offer them something else in exchange. I don’t know if you’ve had this experience with young children when trying to take a breakable item out of their hands. A smart parent grabs their favorite toy and exchanges it with them or distracts them toward something else. The same thing can happen in medicine. If you have to say no to a patient then offer something that you can say yes to. Even if all it is good pain management or the hope for a peaceful death.

Have a kind and respectful day.

Moral Distress Part 2. When patients make bad decisions.

In the first part, we looked at one type of nurse’s moral distress. We focused on the stress we feel when we witness things that we know are wrong but feel helpless to do anything about it. Or perhaps we have tried to do something but nobody will listen. Today I want to talk about a different kind of moral distress.

This distress is also felt by healthcare professional but it is different because you can’t do anything about it. This moral distress is when a patient is making a decision that you don’t agree with. Patients are allowed, by law, to make their own decisions, including the decision to stop or refuse treatments even when they know they will die because of this decision. Patients have the right to do this because it is their body, not ours. We have to accept it as healthcare professionals but that doesn’t mean that we have to like it. These kinds of situations create terrible moral distress. Imagine having to stand by and watch someone die, when you know there is something you could do to stop it. You would feel helpless and frustrated and angry. These are normal reactions and this is what our healthcare professionals feel when they have to watch us make bad decisions.

If you are the patient, you need to understand that when you show up at the doctor’s office or at the hospital, the doctors and nurses think you are there because you want them to do something for you. Makes sense. But when you show up and then refuse what they have to offer, they will feel helpless and frustrated with you. You are entitled to make your own decisions but please understand that you are making it harder on the healthcare team. They are caring human beings. In no way am I saying you have to do the treatments because of their moral distress, just understand that the people taking care of you will feel the distress. Ultimately, the healthcare professional will have to find a way to live with themselves when you leave their office or after you die.

If you are the healthcare professional in this situation, one way you can manage your distress is to ask the patient more questions about why they are choosing what they are choosing. When you find out their story, you may be surprised by what you hear. Many times I have found myself agreeing with the patient’s decision after I hear the why. Yes, I wouldn’t make the same decision for myself, but it makes sense for them based on their values and beliefs. You can ask the patient if they are willing to reconsider but do not ask them to try to force them to change their mind. They do not have to justify themselves to you. If they don’t want to talk about it or reconsider, please respect this decision. Another technique I use in this situation is I ask them why they are saying no, in a non-threatening or demanding manner. When I do, I may discover that they have some misunderstanding about the treatment, the situation or the side effects. In having a compassionate discussion, oftentimes I can discover what is really worrying them and help them reconsider.

The last way I can offer for you to make peace with this kind of moral distress is to think about it as if you were the patient. Wouldn’t you want the choice and the right to make your own medical decisions? Would you want me to try to impose my values on you even though we might not be from the same culture or religion? You would want me to respect you. And I would. People have the right to make the wrong decisions. (except in pediatrics) This is the gift and the curse of autonomy. I am not saying it will be easy. Coping with this type of moral distress is our special obligation as healthcare professionals.

Part 1 https://kindethics.com/2009/06/nurses-moral-distress/
Have a kind and respectful day.

“Saving you Money on your Prescription Medications.” Interview with MrMedsaver, Jacob Milbradt, PharmD on July 23rd, 10AM pacific.

Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

If you’re struggling to afford your medication, MrMedSaver.com can help. On average, we’re able to show our clients how to save about 70% on their prescriptions. Here’s what R. Michael Dowden from Farmersville, OH, a recent MrMedSaver.com client, said about his Rx Savings Report:
“I can see already, the biggest benefit is putting information into the hands of the consumer. On some of these, I thought I already had the answers to what was the lowest cost and still effective medicine. Now I have alternatives that I can discuss with my doctor(s).”
Imagine if your mechanic selected which car you would purchase. Not having a firm grasp of fluctuating automobile prices, imagine if he chose your new vehicle without even taking cost into consideration. Instead, what if he based his decision solely on performance, looks, and amenities, and chose a brand new Mercedes? Would you stand for this? Of course not . . . that would be preposterous. Yet this scenario is the norm for the pharmaceutical industry.
Usually, the person who selects your medications (your doctor) has no idea what you’ll have to pay for them. The pharmaceutical industry changes at such a rapid pace that doctors simply can’t keep track of drug prices or developments like new generic availability. In fact, one of the key sources of drug information for doctors is drug company sales reps. These salesmen are highly trained at pushing doctors away from cost-effective generic medications, and toward the expensive brand-name drugs they are promoting. The design of the entire pharmaceutical industry is flawed, forcing you to pay much more than needed for your medications . . . and there’s no one to look out for you.
Now, with the help of Mr. MedSaver, that’s all about to change. Our company specializes in providing an independent assessment of your medication costs, ending with a report demonstrating numerous tactics you can employ to drastically reduce the amount you spend on prescription drugs. Think of us as the Kelley Blue Book for the pharmaceutical industry.
Mr. MedSaver was founded by Jacob Milbradt, PharmD, a pharmacist from Kansas who grew sick and tired of seeing his patients pay too much for their prescriptions. After daily encounters with people who couldn’t afford their prescriptions or who had to make difficult decisions, such as groceries vs. medication, Dr. Milbradt knew he had to do something that would make a real difference. After a large amount of research, he developed Prescription Cost Management—a revolutionary series of techniques that can be used to cut prescription drug costs to a mere fraction of what most people pay.
Now, these techniques have been taken to the next level—Personalized Prescription Cost Management. At Mr. MedSaver, we don’t have inflexible computer programs with “one-size-fits-all” recommendations. Instead we’ll provide you with a detailed analysis of your medications that is personally completed by a pharmacist and is 100% customized to exactly fit your unique needs.
We know how difficult it can be to afford your medications. We also realize how it often seems that there’s no one available to offer any real help. Well, not anymore. At Mr. MedSaver.com, we offer real results. Guaranteed. And remember, you can trust Mr. MedSaver for completely unbiased advice:
• We aren’t an internet pharmacy: The sole motivation of internet pharmacies is to make as much money as possible by profiting off your prescriptions. Because of this, saving you money isn’t a high priority for these companies.
• We don’t offer prescription “discount” cards: Prescription “discount” cards seldom actually offer much of a discount. In fact, most companies actually turn around and sell the data they collect whenever you fill your prescriptions!
• We will NEVER charge you to enroll in a FREE assistance program: Most websites that offer to enroll you in patient assistance programs won’t tell you that these programs are ENTIRELY FREE. Furthermore, these companies aren’t truly interested in saving you as much money as possible. Instead, they focus on continually milking your wallet every month with enrollment fees.
• We aren’t employed by your pharmacy: We don’t work for your pharmacy, and as a result our first allegiance is to you—NOT the company that sells you prescriptions.
• We are 100% independent: The big drug companies hate us, but you’re going to love us. That’s because we tell it exactly how it is. We have no financial ties to any pharmaceutical manufacturers. Also, we’ll never try to steer you toward pharmacies that have paid us to do this.

Have a kind and respectful day.

My dad would say that, “Dying is difficult because we have never done it before.” But we don’t need to be afraid because our bodies know how to die.

My dad would have told you that, “Dying is difficult because we have never done it before.” But we don’t need to be afraid because our bodies know how to die.

A few hours before my dad died, a couple of his friends stopped by to say their goodbyes. His friend Mary asked me, “What do you think your dad would be saying right now?” I said, “He would probably say that dying is difficult, because we haven’t done it before.” The reason I told her this was because he used to say the same thing about aging. “Getting older is difficult because we haven’t done it before.” How true both of these statements are because anything that is unknown to us can be scary. If we had done it before, we would know that it isn’t as bad as we thought it might be. We might realize that there can be profound lessons in aging and in dying. We might be at more peace during the dying process because we would know that our bodies know how to die. What do I mean by this? The act of dying is sometimes referred to as the labor of death. It is actually rather similar to the labor of birth, though hopefully a lot less painful. Let me explain.

When you were about to be born, your mother didn’t have to say to her uterus, “Please contract now and began to push the baby out.” Or, “Cervix, please dilate so the baby can come out.” Your mother’s body knew what to do and the labor of birth happened naturally. The labor of death is similar to the labor of birth because your body knows what to do. As you begin to near the end of your life you may begin to sleep more and to become less interested in the world around you. You may not have the strength to the things you used to do. As death gets nearer, you will begin to sleep even more and to eat even less. You’re just not hungry anymore and that is normal and all right. Your body knows that it’s time to shut down and that it doesn’t need extra food to keep it going.

Your body goes through predictable and peaceful changes as death approaches. Your skin will get cooler and your breathing patterns will change back and forth from fast to slow to barely there. You may get a fever. There are many other symptoms that you might also experience. You probably won’t be communicating at all at this point. But you can still hear and feel your family. Your loved ones should still talk to you as if you are there and hold your hand, give you a massage or climb into bed to embrace you. If you would like music to be played, then play their favorite songs.
They should do whatever they think you might like to comfort and support you.

It’s great if you have a hospice team in place to support you through this process. They can educate both you and your loved ones about what to expect at each stage along the way. Not everybody dies the same way but there are predictable patterns about what to expect. You don’t need to be afraid. You knew how to be born and you know how to die.

There is more information available on the Hospice Foundation of America website at www.hospicefoundation.org

Have a kind and respectful day.

Be careful about going 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.

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