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.

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.

Today is National Healthcare Decision Day

If you read Monday’s blog you will know that medicine can be corrupt and the best defense you can have is to put your wishes in writing. So, what should you be doing today?

1. Talk to your loved ones about what you would want if you were going to live in a terrible condition. And talk to your loved ones about what you want if you were dying. Not just the medical choices but where and how you would want to die and what else might make it a good death for you.

2. Tell your doctors about all of these wishes as well.

3. Fill out your advance directive for healthcare decisions. Go to my resource page to download an advance directive. Print out copies for everyone you care about.

4. Give copies of your completed form to your loved ones and all of your doctors and your local hospital. Keep a note in your wallet stating the phone numbers of your decision makers and where your advance directive is kept. It should be kept on your refrigerator, in your medicine cabinet or at your bedside.

5. Be comforted in knowing that you have taken care of things so it won’t be a burden on your family. It is a gift to them to make sure they aren’t burdened by having to make these difficult decisions for you.

6. If you need help, please contact me at viki@kindethics.com.

Have a kind and respectful day.

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

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–>

Hospice Foundation of America Teleconference – Diversity at End of Life

It is time for the 2009 National Bereavement Teleconference – Diversity and End-of-Life Care put on by Hospice Foundation of America. Wednesday, April 29, 2009

The program will focus on ways of understanding diversity and how cultural histories, traditions and beliefs can affect end of life care.

You can find out who is hosting a viewing in your area at http://www.hospicefoundation.org/teleconference/default.asp

The Hospice Foundation of America puts on a great educational presentation every year at this time. This year we are lucky because an encore presentation will be available.

A replay of the live event will be available, via webcast only, beginning at 7:30 p.m. EDT (4:30 p.m. Pacific Time). Continuing education credits (CE’s) are also available for both the live program and the encore presentation. However, it is required by boards for continuing education credits to host a 30-minute local discussion, held directly after each program.

Learning Objectives

1. Define diversity and discuss sources of diversity such as ethnicity, class, sexual orientation, religion, and disability;
2. Describe the ways that cultural diversity can both complicate and facilitate end-of-life experiences, including grief and adaptation to loss;
3. Discuss the knowledge, sensitivities, and skills necessary to work with culturally-diverse populations in end-of-life care;
4. Assess the challenges hospice and palliative care present for culturally diverse groups including, but not limited to, African-Americans, Latinos/Hispanics, Asians and Islamic-Americans;
5. Describe effective strategies and programs to work with end-of-life issues with culturally diverse populations including, but not limited to, African-Americans, Asians, Latinos/Hispanics, and Islamic-Americans.

Have a kind and respectful day.

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

Is my grief normal? Do other people cry this much?

Ask Viki

Is my grief normal? Do other people cry this much?

I was sitting with a friend whose husband died 6 weeks ago. She wept and talked then stopped crying and talked then wept again. At one point she asked me, “Is this normal? Do people who you help act like me?” The answer of course is yes. Tears are a normal part of grief. And tears don’t go away quickly. They may last for a lifetime. But the good news is it does get better. When my dad died, the tears wouldn’t stop. Then after a few weeks, the tears only came a few times a day. And now years later, the tears only come up a few times a month.

You shouldn’t have to apologize or excuse yourself for real emotion. If you didn’t love the person, then you wouldn’t cry. And if you aren’t crying, that is okay too. Everyone uses different emotions to process their grief. You may be angry or tired or numb. The only thing you need to do is to experience the grief and overtime it will get easier. If it isn’t getting easier, then get some help.

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–>

When to take your patient’s car keys away.

I know that you know you are responsible for reporting those who should not be driving to Department of Motor Vehicles according to the laws of your state. But are you doing it? Do you know how to do this evaluation?

I am encouraging you to take this responsibility seriously. Not only to protect the patient, but to protect your family as well. The impaired driver is driving in your community and is a danger to you and me. Please take this burden off of the patient’s family. They probably know that their loved one shouldn’t be driving anymore but they don’t want to hurt their relationship. Or they don’t want to see the truth or are waiting for you to do it. This is one time that being the “bad guy” is truly being the “hero.”

This issue is not limited to the elderly. It affects those with sleep disorders, those taking certain medications, and mental and functional deficits.

The American Medical Association has a guidebook to help you. The Physician’s Guide to Assessing and Counseling Older Drivers as an educational tool to assist them in helping their patients. (CSA Rep. 6, A-03)

You can download it free at http://tinyurl.com/cp8uvk

Have a kind and respectful day.

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

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–>

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