March 16, 2018

Another opioid crisis: There's not enough

In an attempt to address the opioid addiction and overdose epidemic in America, the government ordered a 25 percent reduction in injectable opioid production last year and an additional 20 percent reduction in 2018. Guess what? We now have a shortage of the needed supply for patients who deserve pain relief for surgeries, post-procedure recovery and chronic conditions. It has also resulted in dangerous errors as providers attempt to address their patients' palliative needs with substitute substances and procedures.

This Kaiser Health News update tells the story:  Kaiser Health News - March 16, 2018

Be aware of this potential issue as you advocate for yourself or a loved one. 

March 9, 2018

Keep your mitts off my Medicare card!

If you're on Medicare, watch the mail for a new member card--they will be issued nationwide over the next 12 months. Not surprising, it has become a perfect opportunity for scammers to try to glom onto your personal information.

Spread the word among your friends and family to JUST HANG UP on anyone who calls asking for personal information such as a social security number or new Medicare member number. The scammer may threaten to stop Medicare coverage without the verification. JUST HANG UP!

Read more details here:  "Medicare scams center around issuance of new cards" 

and stay on top of other scam alerts at the Facebook page of the Iowa Senior Medicare Patrol (SMP):  SMP Facebook Page.

February 27, 2018

Valuable info in ElderCare Guide!

Am pleased to be a contributing author to Western New York Family Magazine's 16th Annual ElderCare Guide:  Western New York Family Magazine ELDERCARE GUIDE (page 44). 

This magazine is jam-packed with valuable information on caregiving, being part of the sandwich generation, signs of dementia, having crucial conversations about stuff we don't want to talk about--you get the theme. It's all about helping us help ourselves and others.

A big thank you to publisher Michele Miller for inviting me to be a part of this valuable resource!

It ain't braggin' if'n it's the truth!

Iowa has just been named the nation's #1 state, when measured by our Health Care, EducationEconomy, Opportunity, Infrastructure and Quality of Life!  I am especially proud of our high ranking in the Health Care category.  U.S. News and World Report

I always knew Iowans are smart, but it's nice to have everyone else know we're also health literate!  Bravo for us and so proud to be an Iowan!

February 15, 2018

Revisiting a great book

I wrote this review of "When Breath Becomes Air" when it was released in 2016. I picked it up again the other day, reread it and decided its story deserved to be told again. 

Meet Dr. Paul Kalanithi, author of When Breath Become Air. He was a 36-year-old neurosurgery resident when he first viewed the MRI clearly revealing his own lung cancer. He later admitted that until his illness, he knew a lot about pain but he didn’t know what it felt like.
Yes, it’s about dying, but half of this little book focuses on Paul Kalanithi before the cancer, living a life unknowingly crammed with preparatory steps. He got his master’s degree in English literature prior to medical school; his plan had been to spend 20 years in surgery and then 20 years as a writer. Instead, he spent seven years in residency and a few months feverishly authoring this book, which is not just well written but seriously literary. His relentless search for what makes life meaningful even in the face of death and decay had begun with his college admissions essay, in which he argued that happiness is not the point of life. In his brief career as a surgeon, he labored to save what made a patient’s life worth living, if possible, or to allow the peace of death, if not. It was an ideal he adopted for himself when his oncologist counseled that the first step in the medical decision making process is to find one’s values. Dr. Kalanithi passed away eight months after he was told, “You have five good years left,” but as the author graciously allowed, “Doctors, as it turns out, need hope, too.”
We like it when doctors write books. We know they play an extraordinary role in the theater of life and we want a peek from their vantage point. Among the best are Dr. Atul Gawande’s Being Mortal, which gave us a candid view of the healer’s role in shared decision making; I’m still here: Living Long and Loving Life at Age 90, written by Des Moines area cardiologist Dr. David Lemon, filled with his witty and wise patients’ observations on the pageantry of life; and the unique and inspiring stories of hospice care in Dr. Ira Byock’s The Four Things That Matter Most. But Dr. Kalanithi’s book trumps them all because he is not just contemplating the end of life, he is contemplating the end of his life. Part memoir, part condensed treatise on the meaning of life, part manual for the soon-to-be-dying, When Breath Becomes Air is very nearly flawless.
Is there reason to believe that physicians deal firsthand with illness and dying differently than their patients? I don’t think so. We all learn the tough lessons of being a patient when—and not a moment before—we become one. As doctors age, I believe their odds of understanding that no longer treating the disease is not the same as no longer treating the patient are about the same as for the rest of us. And, like the rest of us, the ones that figure it out will be better equipped to practice shared decision making and to accept the inevitability of life’s end. Because, as Dr. Kalanithi recognized soon after his terminal diagnosis, “My relationship with statistics changed as soon as I became one.”

February 7, 2018

Health literacy is for doctors, too

Doctors as well as patients need health literacy. I just came across a "Perspective - Less is More" essay in the JAMA Internal Medicine that makes the point better than I ever could. (Unfortunately, JAMA does not allow me to make the two-page article available to you, but you can see the first page online and then ask your internist to borrow his copy!)

Two young doctors--and brothers--shared the story of taking their grandfather home from the hospital:  "Dying at Home - Our Grandfather's Great Escape".  Besides acknowledging the typical end-of-life trajectory in Canada and the U.S. (repeated trips to the hospital and being "weaker and more discouraged" upon returning home each time), they also write eloquently about how their family pulled together as advocates for their grandfather in his final days.

These young doctors nailed it when they observed that care at the end of life--and for all chronic and critical conditions--is more than just asking about advance directives. Preserving patient autonomy requires complete and effective patient-provider communication, while respecting the patient's dignity and values. 

This is the part I was most drawn to: "Certainly our health literacy, knowledge of existing public resources, and financial means for accessing private services when needed all helped ensure that our grandfather was comfortable and cared for at home." Health literacy. Not their obvious expertise as health care professionals, but their ability to access resources and make informed and shared decisions. Health literacy is the same for all of us.

And this is the part that most concerns me:  It is the second time in as many days that I have heard doctors analogize a hospital to a prison, with phrases such as "making the 'Great Escape'" and "busting them out of there." If that's indeed what health care in the final chapter of life has come to, let us hope the wardens, guards and prisoners can work together to make needed changes.

To Dr. Nicolas Chin-Yee of The Ottawa Hospital and Dr. Benjamin Chin-Yee of the Department of Medicine, University of Toronto, I thank you for sharing your personal story. The quality of patients' lives to the very end of life depends on the health care providers of your generation. And I thank you for speaking truth to outdated attitudes. I hope you will continue to be inspired by the "quality finish" your grandfather had.