Have a Story to Tell? Had a medical error?
Frustrated with a health problem?
Friday, July 22, 2016
Wednesday, July 20, 2016
Tuesday, July 5, 2016
Friday, July 1, 2016
Another story from Dr. Maren Batalden:
A few months ago, I treated an elderly gentleman with cancer who was getting chemo, so his immune system was compromised. He got a urinary infection and ended up in the ICU [intensive care unit] with sepsis, needing specialized attention to support a very low blood pressure. He got better surprisingly quickly with antibiotics and fluids. He came to the regular medical unit late the following afternoon where I became the doctor in charge of his care. I met him the next morning and he told me he felt fine and was ready to go home. He’d been quite sick, so I wanted to watch him another day, especially because we didn’t yet have the culture results from the bacteria which caused his infection and we didn’t know which antibiotic would be safe for discharge.
I explained my concerns to him. “When will you have the culture results that describe my bacteria?” he asked. I said tomorrow. So he asked, “How about if you give me a dose in the hospital of an IV antibiotic that works for 24 hours, give me a prescription that is your best guess about an antibiotic pill that you THINK will treat my infection, let me go home, and call me tomorrow if we need to change the antibiotics. If we need to change it, we’ll change it then.” I thought it was a great idea! He said, “Why should I sit in the hospital waiting for lab results?! If I feel terrible, I’ll come back.” He did great! I called him the next morning; the culture results confirmed that his bacteria was sensitive to the antibiotics I had prescribed. He felt well and continued his recovery without complication at home.
It used to be that when it was time to discharge someone, I figured it was largely my decision to make. Many patients assume the same. “You’re the expert, doc. You tell me.” But I have come to realize that it’s NOT my decision; it’s a shared decision. I understand what the labs and the physical exam are telling me. But I don’t know really know how the patient feels compared to his or her usual state; I don’t really know what kinds of supports they have or don’t have at home. Decisions about whether and when to admit a patient to the hospital and whether or when to discharge have to made together. To my surprise this framework has pretty significantly changed my practice. I find myself keeping people in the hospital for another day or two, when left to my own devices, I might have discharged them earlier, or vice versa. The best care, I have come to believe, is always “co-produced.”
Thanks to Dr. Maren Batalden for her story. Read her article in the British Medical Journal on co-production of medical care.
Monday, June 27, 2016
Thursday, June 16, 2016
Friday, June 3, 2016
This is Part 2 of Debi Janway’s story about her mother’s care at Planetree. You can read Part 1 here.
It was a home-like feeling. I was here late in the evening, and my family would come. The waiting room in MedSurg is home-like, with round tables to eat at and relax with nice chairs, on the same floor as my Mom. So you know if the doctor or nurse wants to see you, you’re right there. You can heat up your own food in the kitchen that’s right there. If your family member is allowed to eat the same food while she’s in the hospital that she eats at home, you can cook that food for them.
They did aromatherapy. Mom absolutely loved the lavender they’d put in her room, it was so soothing. It was very quiet. You could hear a pin drop. No one just entered the room; they always knocked first, and asked, Would it be all right to come in? The lab techs would ask, Is this a good time to come in? It wasn’t intrusive. They’d ask, Is there anything else I can do for you? My Mom might say, Yeah, I’d like some more ice water. The lab tech or whoever would get her what she needed. As a Care Partner, we could do that too.
Hospital CEO Susan Stone adds:
We have a program, Lights Out Lavender. We’ll do a back massage for the patient, and ask if they’re ready for bed. Our staff round every hour.
We worked hard to make it quiet at night. For example, we have reminders to make sure the environment is quiet. We did an assessment and realized that the Housekeeping carts were too squeaky. The doors for the patient laundry used to click shut really loudly, so we’ve changed those. Also, we use soothing sound machines if patients like them, to create white noise, which can sound like rain, or the ocean.
Ken’s comment: The healing environment creates tangible results. Patients have high satisfaction, as do physicians and other staff. The environment seems to quicken healing, as patients’ length of stay is significantly shorter than in a comparison unit, according to “A Retrospective Evaluation of the Impact of the Planetree Patient-Centered Model of Care on Inpatient Quality Outcomes," abstracted here. Even so, the hospital has been profitable since 2010, perhaps because so many have heard about the spa-like hospital.
Thanks to Dr. Susan Stone and Debi Janway for sharing their story.
Thursday, May 26, 2016
Wednesday, May 25, 2016
Thursday, May 12, 2016
Two years ago I had a knee replacement. They had a two-hour class for ten of us having a joint replacement. They required it as preparation for surgery. They gave us an overview, and then also tools, for instance a calendar. They led us through an exercise: Put your surgery date on the calendar, then go ten days back and write down a note to stop your Motrin or other anti-inflammatory meds; and then lay out the future, with your post-op appointment ten days out. They told us what kind of healing you should see within two weeks. It was really comprehensive.
Monday, April 25, 2016
David Woolery was in the Marine Corps in eastern Afghanistan in 2004 when a bomb exploded under a convoy he was in, injuring some of the men. He got through that with the help of his fellow Marines, but the return to the U.S. was more unsettling.
“Out here is every man for himself,” he said. People back-stabbing. It’s all me, me, me.”
In 2015, Mr. Woolery started a Buddy Check 22 Facebook group for his unit, which was “a big lifeline” that later expanded to other veterans. They shared stories of combat, spoke the same language. Recently, a member dropped a screen shot of a veteran’s suicidal remark into the group’s page and wrote, “Let’s find this guy.”
“The man had said his good-byes and was about to kill himself,” Mr. Woolery said. But word spread, and eventually people tracked him down and sent help. It was lifesaving through crowd-sharing.
Why the name “Buddy Check 22?” To thousands of veterans and active-duty soldiers, the 22nd of every month is a reminder to make a suicide prevention spot-check on former comrades. A Department of Veterans Affairs study in 2012 said an estimated 22 veterans committed suicide every day in 2010. While other studies calculated a lower tally, closer to one or two per day, the number 22 has taken on potent symbolism on social media.
Advice to veterans: Join this group.
Read another suicide prevention story. Thanks to Christine Hauser of the New York Times for the source article on April 24.
Friday, April 22, 2016
As the Director of Oncology Intake at Cancer Treatment Centers of America, Dr. Larry Altshuler has been an integrative medicine specialist for 36 years. Here’s an excerpt from his new book, Doctor, Say What?: An insider's scoop to getting the best medical care:
Denise is a 32-year-old woman who had severe IBS [Irritable Bowel Syndrome]. Her IBS had been present for 20 years, and she could never go out because she might have a sudden attack of diarrhea at any time. While exploring her subconscious through the interactive imagery technique, we discovered that some type of fear had started the condition. I had her image her fear, and suddenly she saw a big, black, hairy rat in a cage (this represented that she had “caged” away her fear). I I told her to imagine opening the cage and letting out the rat (symbolically “releasing her fear”). When she did, in her mind, she heard the rat say, “Thank you for releasing me.” I then asked her to see herself hugging the rat (symbolically “embracing the fear”). When she did, the image of the rat changed into a bunny rabbit and hopped away, and she heard it say, “Thanks. You don’t need me anymore.” After that session, Denise never had another episode of IBS, and that was 12 years ago.
Interactive Imagery (also called Active Imagination)…is significantly more powerful than guided imagery…Instead of creating specific images, you allow your mind to spontaneously present images to you. These images represent your symptoms, illness, or emotions. By interacting with these images, you can gain understanding of why you are ill and how you can heal yourself.
Certainly, many of you may think this is in the realm of science fiction, but having used this process with hundreds of patients (most of them skeptical), I can tell you it’s real.
Read another story of a doctor as a caring thought partner. Thanks to Mallory Campoli of Smith Publicity for connecting us.
Monday, April 4, 2016
Thursday, March 31, 2016
A 17-year-old girl, Mariah Edwards, had a routine tonsillectomy, with Fentanyl as a pain killer. However, right after the outpatient surgical procedure, she stopped breathing, but no one noticed this for 25 minutes. The only automatic monitors of her vital signs had been muted. And no one saw her because a curtain had been pulled around the post-op bay. She died days later from the lack of oxygen. This tragedy could have been prevented with proper post-op monitoring and care.
Her family’s lawyers at Ross Feller Casey have posted online a free checklist of questions that patients or their advocates can ask beforehand to assure themselves that doctors and nurses will safely care for their family member. This is particularly important because the first few hours after surgery are often the most risky due to the use of anesthesia, the delivery of pain medication, and other complications that can arise in the recovery room.
Don’t be shy about questioning credentials or asking about post-op care. You are putting your trust, medical health, and quite possibly your life, in the hands of these people, so it is absolutely appropriate that you want to know about their experience and what to expect in the recovery room. You can, and should, ask to talk to whoever will be participating in the operation. It’s not unreasonable to request to talk with the anesthesiologist, surgeon, and other members of the surgical team before any surgery is performed.
Remember, it is just as important to ask about what will happen after the surgery as it is to ask about the procedure itself. You can ask about anything that you find relevant to the operation and time spent in recovery. It’s a good idea to make a list of questions prior to surgery so that you don’t forget any. Sometimes asking the right questions about post-op care can make the difference between a positive medical outcome and a tragedy.
Read another checklist story. Thanks to Mario Cattabiani, the Director of Communications at Ross Feller Casey in Philadelphia and David Bernard of OutpatientSurgery.net for this story.
Friday, March 25, 2016
I have a minor medical condition for which my doctor suggested an over-the-counter nasal spray, Flonase (fluticasone propionate). Sometimes, for months at a time I’ll take it daily, sometimes every other day, sometimes less often, which my doctor says is fine. The bottle says it contains 120 metered sprays. How to know when it’s time to replace it?
I keep a scrap of paper and a pen next to it in my bathroom, writing down the date as I administer it to myself each time. I can count the dates I’ve written so I know when to get a new one. By doing that, I don’t throw away a bottle with usable medicine, nor keep using a sprayer with no medicine.
This could be useful for anyone who wants to consistently take medicine. It’s most useful for medications you’re taking on something other than a daily basis. For daily medicine, a seven-day pill box organizer, or something similar, is probably more convenient.
Sunday, February 7, 2016
Sunday, August 16, 2015