I don’t use the Golden Rule, I use the Platinum Rule.

What is the Platinum Rule? Let me tell you how it differs from the Golden Rule. The Golden Rule, which is found in almost every religion says, “Treat people as you would like to be treated or Do unto others as you would like to be done unto.” The Platinum Rule is even better. It says, “Treat people as they would like to be treated or Do unto others as they would like to be done unto.” It is actually a more respectful way of treating people. The Golden Rule assumes that everyone is the same and would want exactly what you would want. But we aren’t alike and we can get into trouble making this assumption. Let me give you an example.

When someone you know has died and people want to give you comfort, “Do you want people to hug you or would you prefer people to not touch you?” Well, I am a hugger so if I use the Golden Rule, then I am going to hug you whether you like it or not. But if I use the Platinum Rule, then I am going to ask you if you could use a hug and depending on what you tell me, I will respect your answer.

The Platinum Rule works really well in America. We are all different. We have different religions, cultures, values and basic preferences. What I personally believe in is respect. Therefore, I will ask how you like to be shown respect and try to honor it. That is why if you tell me you don’t want to have surgery, even though you might die without it, I will respect your answer. I won’t agree with it but it is not my body that has to go through the experience. It is yours. And you are the only one who can say what is right for your life and your body. Now I might ask you if you would consider changing your mind because I don’t want you to die, but ultimately, it is your decision.

I will respect you and I hope that you will consider asking me how I like to be shown respect too.

Have a kind and respectful day.

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

When I go to the Emergency Room, why is the wait so long?

Dear Viki,

When I go to the Emergency Room, why is the wait so long?

Basically there are only so many beds in a hospital and an emergency room. If there is overcrowding in the hospital, the emergency room will get overcrowded with people waiting to be admitted to the hospital. I know someone that spent three days in the emergency room because there were no beds available in the rest of the hospital. She got her meals, her physical therapy, her medical tests, her x-rays, etc done while she lay in the hallway of the ER. Eventually she got better and was discharged home. She never made it to a regular hospital room.

So how long you will wait to be seen in the emergency department will depend on many factors. Here are just a few:

• How many people got there before you
• How sick you are
• How sick the other people are
• How crowded the whole hospital is
• How many ambulances are arriving outside
• How many other ER’s are available in your area
• People go to the ER when they have a cold or aren’t really sick and take up the doctor’s time
• People go to the ER because they don’t have insurance and the ER has to treat you even if you can’t pay
• People go to the ER because they didn’t want to take time off from work to go to their doctor’s office
• People go to the ER because they kept waiting and hoping they would get better and by the weekend, they still aren’t better

If the other patients already there and those in the arriving ambulances have a more life threatening condition, your wait will be really long. Sorry. Basically the nurses will do something called triage. They have to evaluate who needs help right away and who can wait. I live in an area where many of our emergency rooms have closed because there wasn’t enough money in Los Angeles to keep them open. It puts tremendous pressure on the hospitals that still take care of emergency patients and increases our wait time.

What can we do?

1. Don’t take it out your anger and frustration on the nurses and doctors in the emergency department. They know you had to wait and they wish it was different too. When they go to the ER themselves, they have to wait. They understand and are doing the best they can.

2. If you aren’t really, really sick, go to your doctor’s office. Or go to the urgent care.

3. If you are sick on a Friday morning, go to your doctor’s office. Don’t wait until 6 PM and then go to the ER.

4. Go prepared. Bring all of the medicines and other pills that you have been taking with you in a bag. You shouldn’t be surprised to have to wait.  Bring something to read or do with you.

5. Ask your state to provide more resources for the local hospitals.

Have a kind and respectful day.

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

April is National Donate Life Month (Organ Donation month)

No, you don’t have to actually donate your organs this month but it would be great if you registered as a potential donor. Did you know that if you only sign the card that comes with your driver’s license saying, “I want to donate my organs” then your family can go against your wishes and refuse the donation. You must register your desire to donate your organs with your State Donor Registry or in person at your Department of Motor Vehicles. You can register right now at:

http://www.organdonor.gov/donor/registry.shtm

Just click on your state and follow the instructions. You should also let your loved ones know about your organ donation preferences. That way if they are in ever in this situation, they will know that this is what you wanted and that they need to be respectful and cooperative with the organ donation process.

Who can donate?

Age, most medical conditions or sexual orientation do not exclude you from being a suitable organ and tissue donor. (In fact, there has been a 93-year-old kidney donor and a 99-year-old cornea donor!) There are very few automatic rule-outs, and due to medical advancements, even some of these may change over time. In the event you are in a position to be an actual donor, medical specialists will evaluate your medical history to determine your suitability to donate. (donatelifecalifornia.org)

Pass this information on. In some other countries, being a donor is automatic. You are a donor unless you decided to opt out. We live in a country where you need to opt in. You have to choose to save lives by donating.

Other ways to share the message is you can encourage your company, association, union, or other organizations to which you may belong to join the Workplace Partnership for Life. Tell your local high school about Decision Donation, a school program that educates students about donation. Participate in local National Donate Life Month events sponsored by your local organ procurement organization.

For more information: http://www.organdonor.gov/get_involved/donatelifemonth.htm

My mom just died. What do I do with her medicines?

Dear Viki,

My mom just died. What do I do with her leftover medicines?

I am sorry for your loss. This is a great question because the answer has recently changed. In the past, most people flushed their old medicines down the toilet. This was done to prevent accidental poisonings of children and animals who may find medicines in the trash. But today, the Environmental Protection Agency (EPA) no longer recommends this. Sewage treatment plants may not be able to clean all medicines out of the water. This may harm fish, wildlife or us.

Besides taking care of your mom’s medications, you may want to check to see if any of your own medicines should be discarded because they are too old or aren’t needed anymore. The bottle or container will have an expiration date on it. If the medicine doesn’t have an expiration date, unless you know you purchased it within the past year, you should dispose of it as I explain below. Medicines may lose their effectiveness over time, especially if they are in a warm, moist, bathroom medicine cabinet. In rare cases, taking expired medicines can become dangerous and life threatening.

To dispose of drugs according to the American Pharmacists Association:

1. Read the instructions on the medication for specific information regarding disposal.

2. Remove and destroy ALL identifying personal information (prescription label) from the medication container.

3. Take capsules and tablets and make them unusable by wetting, breaking or crushing them; then place them in a childproof container, sealed with tape and toss in the trash.

4. Mix prescription drugs with an undesirable substance such as used coffee grounds or kitty litter and put them in non-descript containers such as empty cans or sealable bags.

4. Empty liquids onto absorbent paper towels or rags and dispose with regular trash.

5. You can also check for approved state and local collection programs or with area hazardous waste facilities.

6. In certain places, you may be able to take your unused medications to your community pharmacy. Ask your local pharmacist what he recommends.

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–>

Caregiver Burnout – Saving the “Other” Patient

Your patient is not the only one who is suffering. Their caregiver is suffering too. And soon, you may have another patient on your hands. You have probably not been the primary caregiver yourself since have been busy helping other people’s families. But I can tell you from personal experience that caregiving can become so overwhelming that I could barely get up and function. There is a profound sense of isolation, fatigue and helplessness that destroys the caregiver. I am an extremely capable and competent person, and if can fall apart due to caregiver stress, then anyone can.

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 If the loved one who is usually supportive and interactive during the patient’s appointment becomes withdrawn and passive, you may have a person in crisis in front of you.

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

If you let the caregiver crash, then the patient is at risk. They both need your help.

What can you do?

1. You can order home health support to get them through this crisis. You can order a visiting nurse, medical equipment or someone to go out and evaluate the situation.

2. Many insurance companies now have patient support systems in place. Find out what is available and have the numbers ready to give to your patients.

3. Create a local resource handout that you can give to your patients. The social worker at your hospital already knows what resources are available in your town and can give you a list of people the family can call. This can also include resources for patients to get discounted drugs from the pharmaceutical companies.

4. There are also free organizations you can recommend in most communities such as meals on wheels, dial a ride and volunteers with groups such as the American Cancer Society.

Did you know that if you put a patient who has been married for a long time on hospice, their spouse is less likely to die within a year of the patient’s death? You truly have the power to heal and save more people than you realize. Take the time to reach out and provide the support people need.

Have a kind and respectful day.

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

The Good News And The Bad News About Hospice

The good news is that I was just in Scottsbluff, Nebraska and their hospice program is doing such a great job of providing people with the option of a good death that 46% of their dying patients are dying with the help of hospice. Amazing. Nationwide the average is 33%-38% with some states as low as 14%. I am even more impressed with what is happening in Nebraska since they are covering 9000 square miles. I know local hospices in Los Angeles that are struggling to cover their few hundred square miles. Usually those who live in rural communities are limited by the minimal medical services that are available. Nebraska has found a way to move beyond those limitations and to get people what they need. I congratulate the hospice workers of Nebraska.

The bad news is that not every hospice is the same. I was told about a hospice in another state that was providing terrible care. They weren’t using universal precautions to prevent infections from spreading to other family members, were putting the patient at risk when transferring the disabled patient and were not calling the family back when they called to complain. Like any industry, there are good and bad hospices and good and bad employees. If you are on hospice and you don’t think you are getting the care you need or they are not being respectful and responsive, change hospice providers. The bad hospice I just mentioned tells people that they can’t change their hospice provider for 90 days. That is a lie. You can change any healthcare provider any day. You are never locked in.

There are many types of hospices. There are inpatient hospices which are part of hospitals, inpatient hospices that are in their own building, for profit hospices, not for profit hospices and volunteer hospices. Any of these can provide good, loving care and most do everyday. It is not the type of hospice but the people running it and working in it that makes the difference.

Should a doctor treat their own family members?

Dear Viki,

What is your take on doctors who take care of patients with whom they have a personal relationship including families and how should hospitals deal with this?

Thanks for asking this question. This is an ethical problem that is regularly ignored and has always bothered me. The quick answer is that doctors shouldn’t treat loved ones unless it is an emergency and no other doctor is available or if the patient is in an isolated place and no other doctor is nearby. This would never be the case in a hospital setting where another doctor is readily available. Hospitals should have a policy against this behavior.  This may be more difficult to deal with in rural communities but every effort should be taken to protect the patient.

I have heard doctors tell me that they can be objective. They may think that they are able to be objective, and maybe one or two can, but they can’t change what the patient is experiencing. Patients may not be willing to tell the whole truth to their family member, may be embarrassed to be examined by the family member and may feel pressured to do what the doctor/family member says even though they disagree with the plan. And it doesn’t have to be only with family members. It can also be a problem with friends who are healthcare providers. Doctors should hold themselves to the higher standard and live by their own professional code of ethics.

Here is what the American Medical Association has to say about it in the physician’s Code of Medical Ethics:

E-8.19 Self-Treatment or Treatment of Immediate Family Members

Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.

It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.

Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV) Issued June 1993.

Your Patient’s Just Not That Into You

Are you the difficult doctor? Are you making things better or worse for your patient and their family? You might be perceived as a difficult doctor if:

– The nurses hide when you come onto the floor

– You will not return phone calls

– You will not listen to the patient/family

– You appear too busy and in a hurry to demonstrate compassion

– You will not respect the patient’s wishes or the patient’s advance directive

– You will not transfer the patient to another doctor who would be a better fit

– You have a bias against the patient’s culture, religion, gender, sexual orientation, etc.

I had a doctor tell me that the nurses hide from him but he was sure he wasn’t the problem. I just smiled as he went on to defend his rude and aggressive behaviors. I tried to explain to him that how you treat a patient affects the medical outcome. Research has shown that if a patient trusts you, they will heal faster. And trust comes from good communication. I told him that I understood that he didn’t mean to be difficult and that he may just be misunderstood because he is so busy.

If your patients aren’t that into you, then here are some strategies to help your patients reconnect with you.

Here is the most important point: We want to turn judgment into compassion. When a person comes into your office, you don’t know what just happened in their life. They may be grumpy, angry, frustrated or sad because they are in the middle of a divorce, their brother just died or they just had a car accident. Whenever I see someone in a bad mood, I give them the benefit of the doubt. I try to be compassionate and give them extra support. Usually, just showing them some kindness turns the situation around and I become a trusted ally.

Other ways to rebuild the relationship:

1. Be aware of your negative expectations. If you walk in expecting the worst, you will get it.

2. Avoid making assumptions. Your assumptions may be wrong. There may be a good reason this patient is being difficult and if you can find out what it is, you can help resolve their issues.

3. Listen more so you can understand the patient’s perspective. Listening itself can be an act of healing. When you listen, the patient feels cared about.

4. When we deal with someone who is difficult, our frustration makes us pull away from them. What we really need to do is to monitor our emotions and reactions so we can continue to be empathetic and compassionate.

5. If the patient continues to be non-compliant, work on maintaining the relationship through an ongoing dialogue. If the patient can rebuild their trust in you over time, they may begin to take your advice. You have the power to change it from a conflicted relationship into a collaborative one.

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.

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