About.com Patient Empowerment

Exhausted Medical Students Making Life and Death Decisions

Mon, 08 Feb 2010 11:58:28 +0000

Picture this:� Everyone in your home, except you, has been sick since yesterday.� Coughing, vomiting, you have (literally) had no sleep in the past 24+ hours.� All you've done is tend to one, then tend to the next, responding to tears, moans and groans, anger, frustration.... And you aren't really sure whether you are even giving them the right care.� Maybe that cold medicine isn't the right kind.� Maybe that queasy stomach elixer is making things worse?

You're exhausted.� The last time you had any sleep was the night before last.� Now, on top of your exhaustion, you are expected to get behind the wheel of your car, maybe to drive to the drugstore.� Maybe to pick up medicine....

Should you get behind the wheel of that car?� Further, should you be making decisions about how to treat those family members in your care, knowing how little sleep you've had? What if you make them sicker? What if they die, because you haven't had enough sleep?

Now multiply this by several days each week, week in and week out - for years.

[Seriously. Close your eyes for a moment and think about it.....]

If you are hospitalized, the chances are excellent that one of your "doctors" -- you know, the ones in white coats with IDs on them that say "doctor" -- is just as exhausted as you would be with no sleep.

Why?� Because resident doctors -- who are still, formally students (meaning, they have a basic understanding of how to help you, more or less depending on how many years they have been a resident) -- can and do (by law) routinely work 24-30 hour shifts, several days a week, for years, during their training.

And if you are admitted to a teaching hospital (which most hospitals are), they will be treating and taking care of you.� Exhausted, having had no sleep, with thirty or forty other patients on their minds -- they will be the people deciding how to treat you.

These residents are found in every care-providing area of the hospital.� In emergency rooms, in surgery, working directly with patients. Working with YOU and your loved ones.

Scientific evidence shows exactly how dangerous this is.� In 2008, the Institute of Medicine published findings on this topic, recommending that residents' hours be reduced as a safety measure.� Yet, today, more than one year later -- few hospitals (if any) have paid any attention.

There are some rules in place.� Yes - residents hours have already been limited -- the limit is those 30 hours at one shift!� Residents are also limited to an average of 80 hours per week -- but that average might mean they work ONLY 60 hours this week -- meaning they can work 120 hours next week!

Could you work those kinds of hours week in, and week out, for years? Then turn around and make life and death decisions, over and over again, for hundreds of people in your charge?

I know I certainly could not.

So what are we patients to do about this very frightening problem?� There are actually two things we can do:

1.� Be aware of the problem.� If you or a loved one is hospitalized, and a resident (which should be noted on his/her hospital ID) arrives to treat you -- ask when they last slept.� That simple. If if seems they've been on the job for more than 10-12 hours?� Then ask that someone else make recommendations for you.� (It's worth a try anyway.)

2.� A grassroots movement to force changes to this overwork and too-little-sleep policy has begun, and you can sign a petition asking for more recognition, and steps to change it.� Called "Wake Up Doctor" - it will take you only a minute to sign.

Have you been directly harmed by an exhausted resident doctor?� If so, then Wake Up Doctor asks you to share your story, too.

There are so few aspects of the big picture of medicine that we patients can improve.� This may be one of them.� I hope you'll spend a few moments learning more about the problem (awareness) and signing this petition today.

I'll keep you posted on progress.

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Exhausted Medical Students Making Life and Death Decisions originally appeared on About.com Patient Empowerment on Monday, February 8th, 2010 at 11:58:28.

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Does Technology Make Your Doctor Sweat?

Sun, 07 Feb 2010 07:59:36 +0000

I am a self-employed business person, and as a result, I am pretty savvy with technology.� I spend my life in front of a computer, I use a blackberry for my email when I'm not attached to my PC.� Both my fax and a toll-free phone number come through my computer, too. I cannot imagine not having these tools and using them liberally.� If I didn't have them, I could not do the work I do, and reach the number of people I reach, NOR could you all reach out to me.

Last week, as I was pounding away on my keyboard, I heard the ba-da-ding! that alerts me to a fax, and then waited a few seconds for it to load into my computer...

The notice indicated it was 10 pages long.� 10 pages!� So I opened it...

And my jaw dropped.� It was someone else's medical records!� A female who weights 287 lbs,� has some major back problems, is taking vicodin and is out of work.

No, I don't know her.� In fact, she lives several towns over from me.� But it seems we must have similar fax numbers.� And if she ever found out, she would probably be very upset, even angry.� I notified the doctor's office that they sent it to the wrong person.� They treated me as if I had done something wrong!� The nurse was clearly miffed when I called.

Then, a few days later, as if he was reading my mind, I found this blog post by Dr. Rob Lamberts who I have cited on this blog before.� In it, he is chastising his fellow doctors for not using technology to the extent they can to improve their delivery of care. Not just email, but faxes, too.� He explained that he's still receiving paper records through postal mail....

He's right, of course.� Technology can be a lifesaver.� It can provide information at one's fingertips.� It can prevent duplication of tests.� It can be highly accurate...

But I don't think the problem is that doctors are afraid of the technology.� I think there are three reasons they don't use it:

1.� HIPAA rules are not clear.� Many doctors will tell their patients that using email is a violation of HIPAA privacy rules -- but that is not true.� I don't know whether those doctors are truly concerned, or whether they use that as an excuse.

2.� They can make more money, or be more defensive, by not gaining ready access to information.� Dr. Rob cited an example of a doctor who ran tests on his patient even though the patient had those exact same tests six months earlier.� With email, that doctor might have known the patient had the tests, therefore the tests did not need to be run again.� But when that doctor is rewarded for running those tests again (not only as defensive medicine, but because he makes more money from running them) then why would the doctor choose email instead?

3.� Email takes time, and that technology time is non-reimbursable for most doctors.� Or at least they think it is -- and why would they want to begin having to figure that out for individual patients?� Mrs. Smith's insurance would reimburse for email time, but Mr. Jones' payer might not.� Email might save time, but email costs time, too.� And most doctors would rather stick with the known quantity.� Maybe they would email with other doctors, but not with patients?� Even then, they would still have to figure out if it was reimbursable.� Time is money, after all.

And maybe that's why your doctor doesn't want to use email.

However, errant faxes notwithstanding, your doctor really has no excuse that is acceptable for not using the technology that's available.� And that was Dr. Rob's real point.

Does your doctor use email with you?� Does he or she use email with other doctors?

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Does Technology Make Your Doctor Sweat? originally appeared on About.com Patient Empowerment on Sunday, February 7th, 2010 at 07:59:36.

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Celebrities and Medical Advice - Revisited

Fri, 05 Feb 2010 07:39:05 +0000

Uncle! And yes, you are right.... partially....

Many of you have either commented or emailed me after reading my post the other day about celebrities dispensing medical advice. I told you I was tired of hearing celebrities tell me what drugs to buy or what medical decisions to make...

What I didn't make clear enough is really quite pivotal to the question. And the exploration is what really separates the emPatient (empowered patient) from someone who only thinks they are empowered.

Here are the distinctions I make:

There are a number of scenarios where celebrities get involved in dispensing medical advice.� Sometimes they are paid to do so, or they profit from doing so. Sometimes they get involved because they have had a personal experience and want to donate their time and recognition to the cause. Sometimes they mix up the two.� Figuring out who has what motivation is the key.� Yes, we need to follow the money.

So - for example - Celebrities may promote a prescription or OTC drug, and are paid for their acting or posing in those ads. It doesn't matter whether they really have that medical problem or not. It's their job to act in that commercial or pose for that photo and they would not have made that commercial or ad if they weren't getting paid for it.� They are giving medical advice.� Not good!

Some celebrities have had an experience, then write a book of advice based on that experience.� If they simply share their experience, and you learn something from that about taking care of yourself that helps you partner better with your doctors -- that's a good thing! Simply making money by selling books isn't the problem.

The problem is when they come between you and your doctor. When they parlay their personal experiences into giving you medical advice (use herbs to cure your cancer, or don't vaccinate your children) - and you take action on that medical advice without getting it confirmed from another credible source, preferably a medical professional...� No way.� That's just plain dangerous.

Some celebrities promote health-related causes.� In some cases they do so because they have been touched by that medical problem themselves, or through a loved one, so -- as VOLUNTEERS -- they donate their time to help others learn about it, and hopefully prevent it.� Think Katie Couric and colon cancer.� Or Kathryn Joosten (Desperate Housewives, The West Wing) who works hard on behalf of lung cancer, and who recently described her efforts at Dr. Lynne Eldridge's lung cancer blog.� Their messages encourage you to get screened, or to control your disease (like diabetes).� They aren't telling you what treatment choices to make.� That's good!

But then there are those who get paid handsomely for showing up at fundraisers or who suffer from problems, then parlay them into profit as paid spokespeople.� They lend their names to causes, maybe or maybe they have not had personal experience with that cause.� Just because you like that celebrity, does that mean you should be donating to the cause?� That's what the charity hopes for. Does it mean you should be buying the same drugs that help them?� No, it does not. Think Kathleen Turner or former Olympian Mark Spitz.� Of course, neither one has a medical degree. The awareness is a good thing.� Asking for their drugs is not. (Here's what to do instead.)

Then there are those who donate time for some things, and get paid for others.� Marcia Cross (another Desperate Housewives actor) is well-recognized for her philanthropy.� She seems to support a dozen different causes... and then she does TV commercials for migraine medicine.� You can see how simple it would be to mix up Marcia-Cross-donating-her-time-to-charities� with Marcia-Cross-getting-paid-for-hawking-drugs -- but there is a huge difference in her motivation, and there should be a difference in how we regard her involvement in that "cause."

Hopefully that clarifies...� We all need to learn to make distinctions between the valuable information -- and the noise.� As with so much of our healthcare, we need to (all together now!) Follow the Money.

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Celebrities and Medical Advice - Revisited originally appeared on About.com Patient Empowerment on Friday, February 5th, 2010 at 07:39:05.

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Gates Foundation Pledges Billions for Vaccines

Wed, 03 Feb 2010 07:15:26 +0000

This article caught my eye. Reported in dozens (hundreds?) of media -- that Melinda and Bill Gates, of Microsoft fame, have pledged $10 billion (yes, with a B) to provide vaccinations to 8.7 million children in third world, developing countries over the next 10 years. That's in addition to almost $5 billion they had pledged previously to kickstart this initiative.

I find this to be a very noble and generous contribution, especially because of the bigger picture ramifications.� This huge sum of money, given for this cause, is more than the sum of its parts.

First, this is a recognition that vaccines work to save lives.� Believe me, the Gates Foundation could not afford to be sued by every family who lost a child to a vaccine if the vaccines weren't safe!

Second, this is a recognition that there is merit in herd immunity.� The goal is to vaccinate 90% of the children in these countries.� That 90% will all but eradicate those diseases, not just in those countries but in the areas that surround them. After all, those germs don't know about political boundaries!� When anyone who is vaccinated travels, they won't be able to spread those germs even beyond their local area.

Third, this is a signal to denialists who think vaccines are some sort of conspiracy to eradicate the world's population, that the rest of the world embraces vaccines.... they work.... they will save lives.

Bill Gates is a smart man.� One reason he is so smart is because he surrounds himself with knowledgeable people.� He cannot, and won't, make huge donations when there is any question if they are a smart move.�� He would not risk lives, his reputation nor his entire fortune on being wrong.

Enough said.

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Gates Foundation Pledges Billions for Vaccines originally appeared on About.com Patient Empowerment on Wednesday, February 3rd, 2010 at 07:15:26.

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Dr. Celebrity: Where Did You Say Your Degree Is From?

Tue, 02 Feb 2010 08:05:04 +0000

(See the follow up post to this one:� Celebrities and Medical Advice, Revisited)

Whether it's Sally Fields pitching an osteoporosis drug, or Senator Bob Dole telling my husband to use Viagra, or Suzanne Somers telling me how to cure cancer, or Jenny McCarthy telling me not to vaccinate my children, I'm so over celebrities dictating medical care to me!

Think of it this way. Suppose your neighbor shows up at your door. You don't know anything about her except that she works at your local power company, is usually neatly dressed, has a sense of humor, and has lived across the street from you for a few years. You trust her because you have observed that she seems to be trustworthy.

What you don't know about that neighbor is that she is a compulsive gambler and is five figures in debt. You also don't know that she is horribly abusive to her husband and kids. You can't observe those things... so you trust her.

So the question is: suppose this neighbor told you that you should be taking a specific drug for your blood pressure? Or that you should ignore what the doctors are telling you, and instead eat nutritional foods to cure your cancer? Or that it's OK if your child gets polio or mumps -- just don't vaccinate him because she thinks it's not a good idea?

Would you believe your neighbor? Would you act on what she said?

Good heavens. I hope not.

So why on earth would you ever believe a celebrity who you know even less about than your neighbor? Just because a celebrity shows up on your TV or on a movie screen on occasion, is usually neat and clean, has a sense of humor and seems trustworthy BASED ON A ROLE, WITH A SCRIPT, AND A DIRECTOR - seriously? You have no idea what that celebrity knows about medicine. You have no idea if that celebrity even graduated from high school, much less went to college or medical school. You have no idea whether that celebrity even believes what he or she is saying....

What you DO know is that the celebrity is making money by giving you that advice. Yes - either that celebrity is being paid by the company that makes the drug being promoted, or that celebrity is selling a book or some other product. As long as they keep doing what they are doing, they will continue to make money.� Sounds suspiciously like snake oil to me....

And as long as you continue to buy their drugs (or 'ask your doctor') or buy their books, they will continue to do what they are doing. It's advertising, and it works.

I'm not the only one suggesting this is dangerous... seems some big-guns in news media recognize the problem, too. both USA Today and Forbes recently ran articles about this problem.� And those celebrities are laughing all the way to the bank as they cash their paychecks!

I hope you're reading this post and thinking, "Of course! I would never!" But I suspect some of you are reading it thinking "Oh good grief, I never thought of it that way."

So here you go... please take this survey.... anonymously! Have you ever pursued medical advice coming from a celebrity?

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(See the follow up post to this one:� Celebrities and Medical Advice, Revisited)

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Dr. Celebrity: Where Did You Say Your Degree Is From? originally appeared on About.com Patient Empowerment on Tuesday, February 2nd, 2010 at 08:05:04.

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Upcoding - Expensive for Health and Wallets, Too

Sun, 31 Jan 2010 08:01:59 +0000

You have a lousy cold and you can't shake the cough that came along with it.� You visit your doctor who listens to your chest, says it sounds like you may have pneumonia, prescribes an antibiotic, then sends you home with an admonition to rest.

Seems like a normal doctor visit, right?

It is.� Unless something else is going on behind the scenes that you don't know about.� In this case we're talking about billing -- because you are the perfect kind of patient who can set the stage for a practice called "upcoding."� That is - cheating the system.

It's fair for the doctor to be paid what he or she has earned.� In this case, the doctor should be paid fairly for checking you over, diagnosing you, and prescribing for you.� The doctor should fairly submit the diagnostic and billing codes (called ICD codes and CPT codes) for those services to your payer (insurance, Medicaid or Medicare).� Then he or she should be reimbursed by your payer for those services.

Unfortunately, each year hundreds of doctors are arrested for billing fraud. They routinely charge for more than they have performed.� Upcoding is one form of healthcare billing fraud -- it uses the basic diagnosis and makes it out to be more than it is for the purposes of billing.� So, for example, you were told you might have pneumonia and sent home with an antibiotic.� But the doctor might bill for pneumonia (without being sure you have it) and might also bill for taking an x-ray (which would have proved the pneumonia) and reading that x-ray.� Might also set you up to return to re- x-ray again in a few weeks to make sure your lungs are clear (even though you won't ever get that additional x-ray) ... you get the picture.

Upcoding costs us all money.� Upcoding can also be detrimental to your health -- future care and future diagnoses.� Learn more about how to catch it, and what do do about it in this article about upcoding.� And see what others have had to say about their experiences with upcoding, too.

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Upcoding - Expensive for Health and Wallets, Too originally appeared on About.com Patient Empowerment on Sunday, January 31st, 2010 at 08:01:59.

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Maybe Rationing Isn't All Bad

Fri, 29 Jan 2010 09:15:45 +0000

My post yesterday about the application of "social justice" to medicine brought several responses that raise the question, "is rationing ever good?"

Dr. Danny Sands commented on my chastisement of the American College of Physicians' new charter which allows for doctors to choose who is worthy of care (and who is not.)� He cited several examples of times when rationing might be a good thing.

He made some excellent points and I agree with him. Those cases, which included such concepts as too-widespread use of antibiotics (which then leads to resistant germs) or the too frequent use of MRIs (which leads to major expense) are examples of where rationing has a benefit.

But in most cases the benefit is to the group - the public at large.� As individual patients, we automatically think that rationing is not in our best interests.� But the fact is, even as individuals, there are times we might look at rationing as a good thing.� Two reasons:� because we are taxpayers, and because sometimes we don't know the science of what may, or may not, be beneficial to our bodies in the long run.

It's all about point-of-view, and is best understood with examples:

From Dr. Sands' examples:� the H1N1 swine flu vaccine -- was so very scarce when it first was available to the public, so the flu vaccine was rationed and provided only to those who were most at risk.

In the big picture, for the general public, according to the tenets of public health, we consider herd immunity, and protecting the general population by protecting the herd.� In this case, the decision was made to protect the weakest of the herd.� Rationing was used to protect the weakest.

For us as individuals, for those who believe vaccines are useful, rationing was bad because we were unable to get the vaccine when we needed it.� Millions got sick.

But for some individuals, those who do not believe vaccines are useful, it made no difference because they didn't want the vaccine anyway. To them, the rationing had a benefit.

Here's another example.� In my new book, I tell the story of Randy Stroup of Oregon.� Randy had a difficult and terminal form of prostate cancer, and his doctor recommended an expensive form of chemo.� Randy was a Medicaid patient in Oregon, and the Oregon Medicaid system has a policy that states it will not pay for treatment unless that treatment helps more than 5% of patients live for five or more years.� That's Oregon's rationing threshold.

As part of the tax-paying public, that seems like a fair form of rationing.� Oregon residents have determined that they don't want to throw away millions of dollars each year on treatments that don't help 95 out of 100 patients when those patients will die within five years anyway.� (And extended further... for those who live beyond those five years, there will be that much more care they must bear the cost for.)

But suppose you are Randy?� Or suppose you live in Oregon and rely on Medicaid, and were diagnosed with cancer or another form of terminal disease?� And this will make you take notice:� Oregon has a law that allows for doctor-assisted suicide.� When Medicaid turned Randy down, they sent him a form letter that offered him suicide as his alternative since they would not pay for his chemo. That was a much better use of taxpayer money, of course. (However, you should know that Randy put up a huge fuss after getting that letter.� Eventually the state did pay for Randy's chemo.� Sadly, Randy died a year later.)

Rationing is all about the money and resources.� As individual patients, we don't want to be denied anything we THINK we need.� And that's part of the key, too.� Sometimes what is good for us vs what we think is good for us are two different things. There may be times when rationing is good for us:

Your leg is aching and, thinking you may have a hairline fracture, your doctor orders an x-ray or a CT scan to see if you have broken a bone.� Nothing is found. But your leg continues to ache, so you go for a second opinion to a doctor who insists on another CT scan or x-ray.� Still nothing.� Later you go to the dentist who insists on x-raying your teeth, but in the meantime your leg continues to ache so you return to doctor #1 and ask that they x-ray you again because you are sure there is a problem.� But your insurance company won't pay for it.� Your care has been rationed, and your leg still aches.

From your point of view, you aren't getting the care you need.� You're ticked off at your insurer (you may even decide to fight it).� Your leg still aches and you want to know why.

But the evidence shows that too much radiation to our bodies can be dangerous.� In a short period of time, your body has already been radiated three times.� In fact, you were turned down by your insurer for money reasons, but the radiation might have caused you far bigger health problems later.

Rationing is one of those points in healthcare reform arguments that everyone is against.� But the next time you hear someone getting up in arms about it, remember some of what you've read here.

When we wear our taxpayer hats, rationing is a good thing.

When we wear our patient or caregiver hats, rationing may be a bad thing, or it may actually help us in the long run.

Can you think of other examples?

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Maybe Rationing Isn't All Bad originally appeared on About.com Patient Empowerment on Friday, January 29th, 2010 at 09:15:45.

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Second, Do No Harm

Thu, 28 Jan 2010 11:10:33 +0000

When doctors officially become doctors, they take an oath that binds them to "first, do no harm."� It's called "beneficence," and the original was called the Hippocratic Oath, presumably originated by the Greek Hippocrates.� The point to the oath was to remind physicians that they are committed to considering the welfare and well-being of their patients first and foremost, and that all other considerations (their own best interests, money, other people, etc) would be secondary to their efforts on behalf of that patient.

In modern times, there are dozens of oaths, not just the Hippocratic Oath.� Still, as doctors become doctors, they commit themselves to considering their patients FIRST.

As many of us patients are all too aware -- somewhere along the way there are too many doctors who seem to lose sight of those oaths they took.....� For too many doctors, a switch takes place when they begin to consider their own well-being or their income first, and the welfare of their patients somewhere after that.� Conflicts of interest mean patients are no longer first.

It's an ethical conundrum for these doctors.� It's like having an affair with greed, with money as the tempting mistress.� That affair with money and personal gain too often leads to a divorce from the vows of medical ethics. They make big money, it feeds their egos, but we have to wonder how they sleep at night.� Of course, the wronged parties are us patients - both our health and our wallets.

The medical profession, of course, is quite aware of the conflict.� According to my friend and colleague, Dr. Rich (About.com's guide to Heart Disease), this conflict first showed up in a medical journal in the late 1990s.

In fact, straying from the original patient-focused oath has become so institutionalized that some have simply decided to change the oath!� If you can't heed it, then change it!

Who's changing it?� None other than the American College of Physicians, with a membership of 129,000 internists (meaning, primary care, cardiologists, infectious diseases, pulmonologists and many others.) They have developed a new charter that says they may now consider "social justice" in their practice.

They call it "just distribution of finite resources." It refers to the fact that resources are thin, and care must be rationed. Yup -- now we patients are only first IF our doctors think we are worthy. And your doctor's interpretation may mean that your well-being will be second in line to what's good for the doctor and/or the population at large.� Now, not only is rationing OK - it's institutionalized.

In truth, I don't think the RECOGNITION of the fact that resources are thin is all bad.� Perhaps admitting the reality of that fact is a good move.� At least reality is a good platform from which to begin.� If we would simply admit that healthcare is being rationed, then we could act on it. That has been Dr. Rich's point and goal for many years.

The problem is that much of the reality of rationing has been caused by these conflicts of interest to begin with.� We have to wonder which came first -- the conflict-of-interest chicken? or the lack-of-resources egg?

In the perfect world, those conflicts of interest would never have developed in the first place.�� There wouldn't be under-the-table payments to providers by drug companies. There wouldn't be research skewed toward certain outcomes that are beneficial to industry wallets but not sick people. There wouldn't be defensive medicine or upcoding. There wouldn't be substandard medical devices and materials being used on or implanted in patients.� There wouldn't be fraud. There wouldn't be a lot of the negatives we deal with, those which exist because of profit-mongering and greed.� All that money being paid out for all the wrong reasons leaves less money to be paid out for the right ones -- improved health and medical care for patients.

If you read the ACP's new charter, in effect its new code of ethics, you begin with a very different picture.� It talks about a lot of positive ideas, and for that I applaud them.� Some are truly excellent.

But when they get to the "justified" reasons for rationing, instead of taking a good hard look at their own role in ever-growing lack of resources, then taking steps to fix THAT problem, instead they are (in effect) saying� "OK -- let's look at 'socially justified' ways of rationing care so we can continue getting our corner of the healthcare money pie!"

If you are a regular reader of this column, you know that I have often explained why doctors are so backed into corners, and why care is rationed the way it is.� I get that.� I get that they need to keep their staff's paid and their office lights on.� I get all that.

Unfortunately most do NOT understand their own role in making their worlds that way.� They are the ones who allowed these conflicts of interest to get so out of hand.� They are the ones willingly accepting all that money that is coming their way at the expense of patients.� Yet most don't see their own conflict-of-interest trees in the midst of the forest. Even if they think they aren't involved in accepting money for "services-rendered" they are complicit with their colleagues who do.

So when they choose to change their oath (pardon me - charter) to institutionalize that rationing instead of working toward improving how their members do business?� Choose to change the oath instead of making efforts to change the profit paradigm so conflicts of interest won't be so tempting?� Choose to change the oath instead of looking at ways to expand the resources so doctors won't be forced to ration?

Nope -- that's like bile in my throat. It's an admission that "we like making money the way we are making it, so instead of changing that model, we'll just make it OK to choose money over patients.� We'd rather decide who's worthy than make efforts toward reforming the medical care delivery system."

And deciding who's worthy -- that's a very frightening proposition. Elizabeth Hartney, About.com's Guide to Addictions understands it well.� Patients with addictions often get short shrift. As do patients who have diseases that are difficult to diagnose.� As do patients who are in a great deal of pain who most doctors choose to avoid all together.

What do you think?� Does this rub you the wrong way like it does me?� Is it OK with you if they change the rules instead of changing the game?� How do you think this will affect YOUR care?

Are you worthy?

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Learn more or join the conversation!

_{NEWSLETTER | FORUM | BIO | TWITTER | FACEBOOK}

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Photo � Podfoto - Fotolia.com

Second, Do No Harm originally appeared on About.com Patient Empowerment on Thursday, January 28th, 2010 at 11:10:33.

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How Participatory Are You?

Wed, 27 Jan 2010 08:19:57 +0000

Empowered patients are participatory patients;� that means we take an active role in decision-making about our health and medical care.� Last fall I described "participatory medicine" to you in a bit more detail, but that's the basis -- YOUR active role in making your own decisions, based on the knowledge you can accumulate about your medical problem.

One major hurdle has been this:� while many of us patients truly want to participate in our own care, we're not finding a great deal of cooperation from the others who must participate - our providers.

Some providers get it!� In fact, some are very cooperative, offering knowledge, learning materials, assistance, discussion.� They are the enlightened ones who realize that two heads -- theirs and their patients (us!) will always be more effective than one.

So what does it take to convince even more providers that participatory medicine is a valuable tool?� A major step in that direction was taken recently when an article appeared in the American Medical Association's newsletter.� It describes the concept, the benefits, how doctors can begin using a participatory model in their practices, and some tools they can use (mostly technology based) to integrate participation in their practices.

Is your doctor participatory?� Do you find your doctor willing to partner with you and work with you to make decisions?

While I usually discourage patients from taking print outs of Web information to their doctors, I'm going to make an exception here -- it's that important and that different:

For doctors you think ARE participatory -- take a copy of this article to them with THANK YOU written on it.� Let them know how much you appreciate their collaboration.

For doctors you believe ARE NOT participatory, or are only partially so -- take a copy of this article with (something like)� PLEASE CONSIDER THIS PRACTICE MODEL written on it -- it will provide not just the idea, but the road map for getting started, too.

Let us know how it goes!� -- and while you're here, please take this poll -- share your assessment of your relationship with the doctor you work with most.

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Learn more or join the conversation!

_{NEWSLETTER | FORUM | BIO | TWITTER | FACEBOOK}

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Photo � Microsoft Image Gallery

How Participatory Are You? originally appeared on About.com Patient Empowerment on Wednesday, January 27th, 2010 at 08:19:57.

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WOW - Website of the Week - Hospital Information

Mon, 25 Jan 2010 10:28:58 +0000

Hospitals are formidable edifices where science, magic, elation, fear, sadness, birth and death come together to shape a healthcare experience.

Hospitals are also excellent representations of how points of view shape medical outcomes, and why we patients must control our hospital experiences as much as possible. Of course, that's not always easy, because the entire reason we must access a hospital to begin with is because we aren't on top of our games.

Our website of the week is a good resource for awareness and preparation - what you need to know about hospitals in order to manage your own expectations before you are admitted, or before you are rushed to the emergency room.

Hospital.com to the rescue. It is targeted to us patients and provides everything from news about hospitals, to tips about how to manage a hospital experience, to information about all the people who work in a hospital, even how to be a hospital volunteer.

I was a bit skeptical when I reviewed this site, anticipating that it would be all cheerleading for hospitals, and less about real experiences. Turns out it's not really either one. It doesn't talk about the good or the bad. Instead it focuses on how patients can prepare for the best outcomes for themselves. A worthy goal.

The only information I'd like to see more of is safety information.� One thing we know is that hospitals can be very dangerous places.� While there are a few articles that address safety, including infections, there could certainly be much more.� But if you spend some time at Hospital.com, then check out the information you can find about hospitals here at the About.com Patient Empowerment site, you should be very well prepared.

Take a look -- and do it now, before you or a loved one needs to be hospitalized!

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Learn more or join the conversation!

_{NEWSLETTER | FORUM | BIO | TWITTER | FACEBOOK}

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Logo � Hospital.com / American Hospital Association

WOW - Website of the Week - Hospital Information originally appeared on About.com Patient Empowerment on Monday, January 25th, 2010 at 10:28:58.

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