Wednesday, December 8, 2010

Survey finds gap in doctor-patient communication

Dr. Megan Wills Kullnat, a fourth-generation physician, communicates with a new patient at her pediatric practice.

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By Michael Lloyd, AP
Dr. Megan Wills Kullnat, a fourth-generation physician, communicates with a new patient at her pediatric practice.

But a national survey of doctors and hospitalized patients finds that, in reality, effective communication often is sorely lacking.

Only 48% of patients said they were always involved in decisions about their treatment, and 29% of patients didn't know who was in charge of their case while they were in the hospital.

"That's terrible," says Beth Lown, medical director of the Schwartz Center for Compassionate Healthcare at Massachusetts General Hospital, which commissioned the survey by Marttila Strategies in Boston. These patients "are orphans" in the hospital, she says.

Eighty-one percent of patients and 71% of doctors agreed communication made a difference in "whether a patient lives or dies," according to the survey of 500 doctors and 800 patients.

"So there's a disconnect between what people say they want and what's happening," says Gregory Makoul, chairman of the American Academy on Communication in Healthcare.

Emphasis on better communication has increased in recent years as the medical community has become more aware of its effect on patient healing. Since 1995, U.S. medical students have been required to get training in communication skills. And in 2005, the United States Medical Licensing Exam began to include testing on interpersonal and communication skills.

Communication skills and high patient-satisfaction scores can give hospitals a competitive edge as well as reduce malpractice claims, says Debra Roter, a professor at Johns Hopkins University in Baltimore.

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I learned something new - the US Medical Licensing Exam began including testing on interpersonal and communication skills in 2005. 5 Years later, I think it's time to review the impact of these skills.

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Tuesday, December 7, 2010

Light a Caring Candle for Elizabeth Edwards

Caring Candle for
Elizabeth Anania Edwards
Breast Cancer
Caring.com: Senior Care

Sponsored by Hospice Volunteer Training Online

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Saturday, December 4, 2010

Diminished Clarity of Goals

The 92 year old woman had a skin cancer that was biopsied.  Following the results, a surgey took place to remove the cancer which was now reportedly an aggressive cancer. It had spread behind her eye and into her skull.  The family was not studying steps to take next but depending on health care professionals to guide them in their decision making.  Surgery would be the treatment option that would be decided on by the family.

A couple of month earlier, this 92 year old woman was still taking daily walks and enjoying her kids, grandkids, and great grandkids.  She would sometimes get my mail by mistake in her mailbox.  "You have a letter here" she would call and say.  "Better come get a cup of coffee with me and see if it's anything important".  The letter would almost always be a piece of junk mail but the kind senior would hold it ransom until me or my husband would come to her house, get the letter and proceed to visit.

I placed a courteous call to my neighbor, the daughter of the 92 year old woman, to inquire about her mother's status. 

"She's on a ventillator.  If she makes it through this, then we are going to discuss chemo and radioation.  Can hospice help her?".

"Really?", I thought.  I knew better than to voice my opinion.  I can't imagine putting someone through that who is 92 and has aggressive cancer so I asked the neighbor to ask the doctor one question.  "Will this treatment be for curing or for just making Mama comfortable?"  Then, I told her the truth.  "If the doctor says this treatment is not for cure, then you know that he or she believes there is a good chance that your mother will not live longer than 6 months".  It may have seemed cruel but I couldn't lead her to believe that hospice is a great service to provide a lot of extra attention but a specialty program for the person who may not live through their disease.  By the way, this did not remove hope but evoked words of gratitude from the daughter,  "That's what I wanted to hear - the truth".

I didn't want to interject too much of my opinion here with fear of making the daughter feel guilty about any decisions she and her family were making at this time. I wanted the doctor to have an opening to begin discussing possible outcomes and hopefully this question would be the prompt.

I took the scenario personally as I do any situation that seems to cause more harm than good.  Mentioning the situation to a hospital discharge planner, I was taken aback at her response.  "Whose to say that this woman won't live until she's 102 and that is what she wants?"  Good point.  Who was I to say that all this was not going to work and offer this woman a long satisfying quality of life?

This is where I began another awakening.  I still have a few of them as I get older.

The goals of care begin to distort because none of us ever know what the real outcome will be.  How can the layperson ever know that the decisions made during a crisis are going to be the best for those we love?  I believe completely in advanced directives like the 5 Wishes form that I present to community groups. However, in moments like this one the advanced directives only tell us that our loved did not want to be eternally hooked up to a machine.  Rarely do we discuss what we want done in the earlier stages of bad news discussions.  In survival mode at the beginning of the roller coaster ride of disease, all decisions are optimistic.  We will try anything and everything and when that doesn't work we will choose not to be kept alive by life support systems.  Somehow we must learn to clarify our goals earlier - or maybe just continue the way we do things now.

Last night, the 92 year old's life ended, 2 days after surgery.

 

 

Robin Watts is the founder of Hospice Volunteer Training Online

 

 

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Wednesday, December 1, 2010

The Hospice Volunteer Daily

The Hospice Volunteer Daily is a great resource for hospice agencies.  I use one of the articles daily in educating the community and referral sources about the benefit of hospice services.

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Thursday, November 25, 2010

Hospice Opportunities/Events

Blue Ridge Hospice: Help is needed sorting donated merchandise. 540-536-5210, www.blueridgehospice.org.

Optimal Hospice Foundation needs volunteers to assist in organizing fundraising events such as the upcoming "Light Up A Life Celebration" that will be held in December in the Bakersfield, Taft, Tehachapi and Lake Isabella communities. If you would like to honor a loved one at the "Light Up A Life Celebration" or you would like more information on volunteering for this cause, contact Foundation Director Ann Smart at 716-8000.

Optimal Hospice Care is looking for community support for the annual Optimal Hospice Care Food Drive that helps provide holiday meals for some of the families in its care. Non-perishable food items and grocery gift certificates from local stores are welcome. If you are interested in donating, contact the volunteer office at 716-4000, or simply drop the items in the Food Drive Donation boxes between 8 a.m. and 5 p.m., Monday through Friday, at Optimal Hospice Care, 4700 Stockdale Highway, Suite, 120.

 

 

http://volunteertrainingonline.com/courses

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Wednesday, November 24, 2010

Financial Wealth Management and Hospice

The microphone clumsily danced before me as I sat in as a guest on a radio show this morning to discuss National Hospice Month, holiday grief, and advanced directives.  After previewing the Facing Death PBS special, my thoughts were not collectively focused on the normal promotion of hospice services. 

Why was hospice only mentioned once in a show about death and dying?  More to the point, why was it mentioned in the context of "we can send you home with hospice....(pause)....or not".  The solution in my mind is obvious and quite helpful to referring physicians.  Look at the patient and family, begin with the usual "we can send you home with hospice" and remove the pause and the "or not". When hospice is mentioned say, "I would like for you to talk to someone from hospice so you can better understand what is available for you and your family and then you can make a more informed decision".  My supposition is that the palliative care teams would have loved to have at least received an honorable mention.  We haven't come quite as far as I thought in the hospice and palliative care field.

Perhaps the local listening audience of the financial wealth management show wondered why hospice would be on a financial show. Ironically, I can make hospice fit into any show because of the holistic services provided by the hospice benefit.  I once spoke immediately following an entertainment segment and very easily related it to hospice.  During that particular show I spoke about making dreams come true for those who are in their last days of life, taking flowers to patients, and serenity that spills over the family when hospice becomes a word of comfort rather than a word to be feared.

The wealth management show went well as we discussed leaving a legacy of peace.  The most important gifts we can leave our family and friends is making decisions about our finances, health care directives, and discussions that reveal our values and memories.  Once we give of these actions, we create peace for those we leave behind. Most of the younger patients tend to ask first about financial concerns (unless they are in severe pain).  "Can someone help me find out about my life insurance?" or "Will you help me with my disability application?" are common inquiries prior to asking anything health related.  Financial questions require the resources that hospice social workers can address and contribute to the course of counseling and support necessary to bring comfort to the patient.

The north georgia mountains a.m. morning show does not reach the magnitude of people that PBS does, but maybe today the show was just as valuable.

 

 

 

Hospice Volunteer Training Online

http://www.volunteertrainingonline.com/courses

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