When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I …
Where is compassionate end-of-life care for the elderly patient?
There is a saying in the world of education, “You have to care to teach.” Why is it then in health care, a profession of and about caring, we do such a poor job of teaching our patients? Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient …
Teach back: Reduce the costs of poor patient education
A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.”
In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care — the added cost of additional care, additional hospitalizations, and the additional …
Miscommunication added to the cost of neurosurgery
I don’t know you and you don’t know me, but today you become one of the most important people in my life. You are the one. The one who I’ve entrusted to take care of my girl in my absence. The one who I’ve tasked with teaching her things that I cannot. The one who will make an indelible mark on her …
On the first day of school, a letter to my child’s teacher
It was July 2012 and I was pregnant with my third child. As an experienced mother and labor and delivery nurse, I felt very comfortable at 29-weeks gestation and anticipated the usual course of pregnancy. However, at 30 weeks, I started battling with preterm labor issues. This eventually led to the early delivery of my son, a four week and stay in the NICU, and a life lesson in cost-awareness …
A life lesson in cost-awareness of medical care
I wish I had a dollar every time someone gets misty-eyed about the physician-patient relationship — and two dollars every time they say protecting it is the key to health care. That might be true, if you thought health care was awesome circa 1960.
Hereʼs what the physician-patient relationship meant back then: Physicians say, patients pay. We have seen little progress since then. The claim that the relationship is now symmetrical …
Fixing the physician-patient relationship
Not long ago, Tracy Hume, a freelance writer who lives in Greeley, Colorado, sent me an email posing this question: “Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?”
It seems that over the July 4th weekend, Tracy’s teenage son was complaining of a headache, nausea and abdominal pain, and was vomiting. He doesn’t complain much, she said, so thinking that …
Increasing hospital revenues through urgent care referrals
My grandmother recently went into hospice care. At 94, she has lived a longer, richer life than probably most of us will ever hope to. Given the nature of the work I do, end of life care is not a topic I’m unfamiliar with. Initially, I spent a lot of time asking my mother probing questions about the care my grandmother was receiving. I imagine I did this partly out …
The parallel world of hospice care
Jessie Gruman, who sadly died July 14, 2014, was someone I greatly admired as a person and as a patient activist. I interviewed her in late April for research I was conducting on patient activism, and she graciously allowed me to publish the interview, wanting, not surprisingly for those who knew her, to do everything she could to use her experiences …
An interview with Jessie Gruman
Beginning with the Institute of Medicine’s (IOM) landmark Quality Chasm report in the late 1990s, the health policy establishment, the medical profession and the American public began to hear a new and disconcerting message: American health care was not patient-centered.
The IOM prescribed a number of recommendations to redesign health care delivery, one calling for patients as the source of control over their care. “Patients should …
In medicine, the patient is not always right
A popular television commercial shows a group of older women playing cards. One woman talks about her friend who is struggling financially since her husband died (the husband only had a small life insurance policy). Another lady said that she doesn’t have to worry about that happening since her husband has an XYZ insurance policy. The other ladies immediately ask about the policy. Then a TV pitchman describes the policy …
Incorporate empathy in patient interactions
Before losing my health insurance in 2009, it never occurred to me to be concerned about a little thing like a blood test. Since 1986 I’d been having three vials of blood drawn each year during my physical. My doctor would authorize it, the nurse would draw the blood in the office and send it to the lab for processing.
A few days later she would call me with the results …
Wildly differing prices for the exact same medical service
I’m impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information.
Buying sunscreen: It’s a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important.
So my colleague was surprised to hear this snippet of conversation as she contemplated …
Authorities overestimate patients’ health literacy
The interview had lasted fifteen minutes so far, and we’d made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora’s medical history together.
A year earlier, Leora, in her mid-fifties, …
Thoughts about suicide post-stroke: A most difficult intervention
It was an ordinary summer day. People were milling on the main thoroughfare, bikes zig-zagging through traffic, cafés and pubs spilling onto the sidewalk, patrons sipping their way through a lazy Friday afternoon.
We were ordinary that day too. Just another family, managing the hectic jumble of kids’ lessons, bills, our careers, endless streams of birthday parties, too little sleep and the occasional date night out.
But it was all shattered with …
Heard these?
Media-fueled flip-flops and research breakthroughs on lifestyle and health behaviors are wearing down my usual patience with …
The effort it takes to become an engaged patient
According to the recent Wall Street Journal article patients are encouraged to engage in care, keep track of their medical data, seek preventive care, and to manage their conditions. Studies show that if patients are actively involved in care and partner with providers, that they experience better health outcomes and lower costs.
But for patients to be active participants in care they must acquire knowledge about their diagnoses and treatment plans, …
Patients need education about their role in care
If only our lives were more predictable and certain, we’d feel a greater sense of security and safety. Yet, much of what happens to us is beyond our ability to control. This is true whether we live in a third-world country or in the most advanced scientific and technological environment. It’s also true whether we’re struggling to make ends meet or living in the lap of luxury.
No one is immune …
The uncertainty that the chronically ill face
What if healthy pregnancies were treated like special needs pregnancies?
Mr. and Mrs. Johnson, good afternoon. I’m Doctor Dumas, a visiting obstetrician in Doctor Kwak’s practice. It’s nice to meet you.
Look, there’s no easy way to say this, so at the risk of sounding blunt, I have some bad news.
The technician and I reviewed your scans and we found that you’re about ten weeks along with a human fetus. I’m not seeing …
A normal pregnancy framed as a one with special needs
We tell ourselves many things about our health each day, every day, all day long. The vast majority are unintentional, uninspired and blunt. A particularly sinful dessert brings admonishment, “You should not have eaten that.” Panting after two flights of stairs call for an exasperated, “I am out of shape!” Receiving a diagnosis prompts mental overdrive of “What if I don’t survive this?” thoughts.
Learning my diagnosis of chronic kidney disease …
5 messages you should say about your health
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