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Monday, April 25, 2016

Buddy Check 22 Facebook group: Life-saving through crowd-sharing

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

Interactive Imagery for Irritable Bowel Syndrome: It changed into a bunny rabbit

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

A specialist's patient-centered care: He won't do one

Throughout his career John Rossi has improved medical care, as an industrial engineer by training.  He's the best, and I was privileged to learn clinical quality improvement from him. -Ken

John's story:
My work makes me hypersensitive to flaws in any system I encounter.  I'm naturally curious about those things; I can't restrain my curiosity.

A few years ago I had pain of uncertain origin that my regular dentist couldn't find.  He referred me to an endodontist, saying "If you don't need a root canal, he won't do one."  Some people in that business will just do the root canal and that's the end of the story.

I was able to get in quickly as a new patient.  From the beginning, the experience was as good as you can make it in those circumstances.  I arrived in pain.  The initial paperwork was easy and brief.  They knew exactly what to do with my insurance.  They had already received my information from my dentist, so I didn't need to do any paperwork.  They told me exactly what it would cost me.  

When I first talked with him, he said, Here are the options, in simple terms about what was going on with the tooth.  I had had a root canal years before, and that experience was very different.  They just got in there and started doing the procedure.  Instead, he said, I can pull the tooth, but you'll have a gap that your dentist can fill; that's the other option.  Or if you want to keep the tooth, I can do that with a root canal.  

Having options is always good when you're dealing with a specialist.

He prescribed pain medicine because he couldn't do it that day.  The pain was kind of bad so that helped.

The next visit was for the procedure itself.  He was able to do the first one in one visit.  That was important because you're in the chair for a long time, with your mouth open wide.  That's not painful in itself, since you have lots of novocaine to block the nerves, but it's irritating to sit there for that long; your mouth gets tired.  An earlier root canal with another endodontist had taken three visits.

He explains what he's doing in advance, and as he's doing it:  how this works, and what he's doing.  He has technique that's very good, that's not difficult to tolerate.  He has an assistant, a surgical technician who passes instruments so can move things along very rapidly.  

He explains the aftermath, and if there's to be a second procedure, he'll explain that, telling me, This will take about this amount of time.  He predicts accurately.  And he'll say, If you have pain later, this is how we'll deal with it.  If I need an antibiotic, he gives it to me.  

I've never had any complications.  

For subsequent times, he can see me quickly, because our relationship is established.  There's no barrier to going there, even though in practices like this, it's not self-referral.  I get in there pretty quickly.

His assistant has already worked out an arrangement with the insurance company so they know what balance I owe, as my insurance only pays a certain percentage.  So she says, When you come back, come with a check in this amount, and we'll send you a check back if necessary.  I usually get a little rebate check. This is expensive stuff, ranging in the thousands, even after insurance.  It adds up pretty quickly!

They're making everything as painless as they possibly can:  the procedure itself, the lead up to it, the check-in process, and the settling of accounts at the end. 

The bedside manner is right there.  He's obviously an excellent technician, with a modern setup.  That's the stuff that's hard for the consumer to judge, other than the lack of pain during the procedure.  His manner is very gentle and calming even when you're in pain.  He brings down the anxiety level by explaining.  He'll do some small talk around the edges to bring the anxiety down, because they know people in this situation are usually in considerable pain.

It's a nice contrast.  Some surgeons are very abrupt with their patients, just saying, We're all set, all right, let's go.  That's not easy for patients or their families.  It's a very different experience with this man.

Overall, it's a collection of things, not one thing. It's all of what they do that meets those patient-centered ways of doing things.  I don't expect it as much of the office staff about the making of appointments, arrangements with insurance, the paperwork, and so forth, but they also make that painless.  While I don't like writing a big check of $1,000 or more, I'm not surprised.  It's not, We'll submit this to the insurance company and see what comes back, like with other dentists.  If I've made an overpayment, they'll pay me back.  It's all done smoothly for the patient.

I've had four root canals with this doctor, and the office process and the dental care are amazingly consistent at this high level of patient-centered care.

I give them a lot of credit for that.  If I do have to have more work done, that's where I'll go.  They've made the experience that good.  That has gotten back to my dentist; that's why he'd told me he had no reservations about sending me there.

Ken's Advice: In talking with a specialist, be sure to learn your options.  (John adds:  "If you perceive a lack of options, alarms should go off.  Be assertive, patients!")

Read a story of a dentist's patient-centered care.