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 And I thank you for speaking truth to outdated attitudes.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. 

January 10, 2018

12-part Health Literacy series in the Des Moines Register

Today marks the first installment of my 12-part series, Health Literacy 101, in the Des Moines Register. I'm grateful to the Register editorial staff for the opportunity to share this valuable content on how to become an empowered patient, decisive health care proxy or more engaged health care professional.

The first installment is background on how medical decision making has morphed over the past four decades. Going forward, some of the key elements of health literacy I'll be covering are how to access reliable information, choosing a provider and watching out for polypharmacy (sorry, but you'll just have to read Installment #8 to learn what that is).

If you appreciate having solid, reliable health care information in The Register, please post an online comment or let the editorial staff know.  If you have a question or suggestion for me, just drop me an email:  JoKline@msn.com.

Thanks for taking the time to become more health literate. Salute!

January 4, 2018

Advance Care Planning vs. Patient-Provider Communication

Remember back in January of 2016, when Medicare approved a benefit to discuss Advance Care Planning?  It was a big deal. I know that because I was one of many who talked (endlessly, it seemed) about what a big deal it was. Our high expectations came from knowing that when people discuss in advance their wishes for care at the end of life, they are more likely to get the treatment they prefer, receive less futile medical care and--guess what--we save a ton of health care dollars.

Well, the results are in. During the first year, more than 570,000 Medicare patients used the benefit, which sounds pretty darn impressive. Here's the deal: That's only about one percent of all the people who could have. But, hey, it's twice the number of patients that the American Medical Association predicted would take advantage of the new benefit.

Now, here's some truly good news: A study at the University of Washington found that when doctors focus on patient-centered care for Intensive Care Unit patients by discussing treatment options and the use of palliative care, the costs per patient go down about 25 percent. Read: having real patient-provider conversations in the midst of a life-limiting health care crisis--along with the conscious practice of shared decision making--has a positive impact on patient care, as well as expenditures. 

Could we have been wrong for the past forty years about the role of Advance Care Planning? Perhaps . . . 

December 18, 2017

Time for New Year's Resolutions as we say ba-bye to 2017

Well, another year has flown by, and with it the "window of opportunity" to change Medicare supplemental plans that comes every year in late November. If you are like most of us, it's a big yawn and a classic if-it-ain't-broke-don't-try-to-fix-it moment. Inertia can easily take over when it comes to health care decision making, for folks of any age.

May I suggest that you approach the coming new year just a little differently than those of the past? Consider making 2018 the year that you take some serious steps toward being health literate.

Step 1. Learn how to access reliable sources of information that you will need for preventive, routine, emergency or end-of-life care decision making, for yourself or a loved one.
Step 2. Become familiar with the process of shared decision making, so you are prepared to be an informed medical decision maker, whether you're facing a new prescription or a life-limiting diagnosis.
Step 3. Take a few simple actions steps, such as creating written records of your medications and medical conditions, and making a written plan for substitute decision making with advance directives.

My promise to you is that when you are finished, you will be a more empowered patient or decisive caregiver for someone else. I promise.

In the meantime, Merry Christmas and Happy New Year

November 27, 2017

Palliative care for Alzheimer's patients

If Alzheimer's disease is touching the life of someone you know, as a patient or a caregiver, please take a few moments to read this post about the potential role of palliative care in a treatment plan for Alzheimer's. GET PALLIATIVE CARE website.

Palliative care is not just for end of life--it can provide needed support for the symptoms of a disease, as well as aiding the patient and caregivers with decision making.

November 10, 2017

National Hospice and Palliative Care Month

Quiz time:  Do you know the difference between hospice care and palliative care? Here's a hint: One is for people who are nearing the end of life and the other is for anyone dealing with discomfort caused by serious disease symptoms or the side effects of treatment.

That's right, all hospice care is palliative care but not all palliative care is hospice. Many of us (close to most of us) have had a loved one pass away while in the care of hospice. Its focus is  on helping the patient have a dignified and comfortable end of life, as well as caring for the needs of loved ones.  All that "comfort" care? That's the palliative part.

This month is a good time to become familiar with what your health care community offers for both options. Ask your friends and health care providers who they recommend and consider taking a tour if there is a residential hospice facility nearby.

"The time to repair the roof is when the sun is shining,"  John Kennedy

As for the angels who work in hospice and palliative care:  God bless you, one and all.