Archives for posts with tag: patient advocacy

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How to Get the Most from Your Doctor Visits:

  As many of you know, I am a medical administrator and work for a family practice physician’s office. My job is to field complaints and issues patients have regarding their care.  Whether it be treatment received by the staff or physician or problems with insurance. It’s my job to get to the bottom of the issue and resolve it. One of the most frequently asked questions patients ask is “How can I get the most out of my time with the doctor.”  I get this question a lot from caregivers, because many of them feel invisible when it comes to taking their loved one in to see the doctor. Many of them feel they don’t have a right to step in and ask questions on their loved one’s behalf.  Caregivers have every right to ask questions regarding their loved one’s health care.  Many times they are the only voice their loved one has.

Getting your loved one to the doctor’s office can be difficult. People with dementia don’t like changes in environment and waiting in a strange place for an extended period of time can be stressful. Whether the appointment is for you or your family member, there are steps you can take to lessen the stress associated with doctor’s appointments while also insuring that you’re provided with treatment and information you need for you or your loved one at the appointment.

Below are 8 tips to help you prepare and get the most out of your doctor’s appointment:

  1. Come prepared: Write down your questions and concerns. Has anything changed with your or your loved one’s health? Tired, aches and pains? Shortness of breath? A skin rash or mole that has changed or bleeds? Difficulty with bowel or bladder. Unable to sleep at night? No appetite? Unintended weight loss or weight gain? Write your questions down before your appointment, so you don’t feel rushed. At your appointment, give the list of questions to your doctor at the beginning of your visit. That way they will be addressed right off the bat. This information will also give the doc an idea what is going on with you or your loved one and will direct the visit towards those issues.
  2. Bring your medication bottles: All of them: vitamin supplements, over the counter medications, even the ones from other doctors who are treating you. This is very important. Your doctors need to know what medications you are currently taking in order to avoid any drug interactions. Common vitamins and dietary supplements can interfere with other medications you may be taking. One example is Tums, a common over- the- counter remedy for indigestion can reduce the effect of Cipro (an antibiotic used to treat urinary tract and lung infections) by 40% by limiting the antibiotic’s absorption, which could result in inadequate treatment or may cause other complications.[1]
  3. Be on time:  This is the most contentious aspect of patient care. No one likes to sit in a crowded waiting room for a long period of time. Contrary to common opinion, doctors are aware of this and are also aware of how valuable your time is. Granted, things do come up like emergencies in the office or at the hospital. Physicians are dealing with people, and sometimes they need more than the allotted appointment time for their treatment.  As important as it is for doctors to respect your time, it is also important for you to respect theirs. If you are not there at your appointment time, that will delay your appointment as well as back up the schedule for someone else. Sticking to the schedule may be difficult sometimes but for the most part, doctors make an effort to keep on time with their schedule. If your loved one has difficulty waiting, you can call the office 30 minutes before your scheduled appointment and ask if the doctor is on time. That way arrangements can be made for you to come in later or reschedule if need be.
  4. Leave the family/neighbors/friends at home: If you are an adult and do not suffer from dementia, it is best for you to be the only one in the exam room in order to avoid interruptions from another person. This is your appointment. It’s your time with the doctor.  If you do require someone to be with you or if you want someone there as a second set of ears to hear what the doctor is saying regarding your treatment, ask them to please be courteous of your time and the doctor’s time by not asking the doctor to treat their medical issues. If the doctor needs to address someone else’s medical problem during your visit, it will take time away from your care and will infringe on the next patient’s visit. This is one of the most difficult and sensitive situations for physicians to deal with.  Most people think it should be no problem for the doctor to treat them during your visit. After all, he’s their doctor too so why can’t he look at the rash on your back or go over your lab work from three weeks ago.  It’s not that doctors don’t want to help- they do. But people need to realize that treating another patient on top of the one that is already scheduled takes additional time and resources. It takes time away from the patient that scheduled the visit and will take time away from the patient waiting in the waiting room. There is so much more to treating a patient than people are aware of. There are important protocols that must be followed in order to provide quality care.  If your family member or person accompanying you to your doctor visit is sick or has a concern, it is best for them to schedule a separate appointment. That way they will receive the doctor’s undivided attention to their medical issue without taking time away from your appointment.
  5. Bring your driver’s license or other government issued form of identification and your current insurance information: In order to make sure you receive the benefits you are entitled to, the billing staff needs a copy of your current insurance card. With the Affordable Care Act in full swing, many insurance networks are narrower, which means the doctor you saw last year may not be on the plan this year. Knowing your insurance coverage helps the medical staff direct your care to the providers who are on your plan. If your insurance has changed, you need to make sure the office staff knows and that the physician you are seeing is a provider for your current insurance. It is important that you are aware of this because you may ultimately be responsible for any charges incurred at the visit.  You can call the insurance company or call the doctor office to verify this information.   Verifying that your doctor is on your current plan will help you will get the most out of your benefits.
  1. During Your Visit: If this is your first visit to the doctor make sure you not only have a current list of your medications (Preferably the actual medication bottles), you should have a list of any allergies-medication as well as non-medication allergies. This information is extremely important in regards to your health care. For example, patients who are allergic to eggs should not receive the flu vaccine because one of the base ingredients is eggs, so it’s important for your doc to know what, if anything you are allergic to. Also, if this is the first time you are seeing this doctor, you will need to know your medical history and your immediate family’s history as well, including any surgeries or serious illnesses. If this is a follow- visit, be sure to let your doctor know how previous treatment worked or not. This will help your doctor decide what treatment will need changed or if staying the course is appropriate.
  1. Communication: If at any time during your visit, you don’t understand the treatment your doctor is prescribing, don’t be afraid to say “I don’t understand”, or “could you explain that in a little more detail.” It is imperative that you understand what your doctor is prescribing and how it is going to help. It is also important to understand what if any side effects may occur. This is especially important when it comes to medication dosage changes or new medications being prescribed. Also, be sure to tell your doctor if you need refills on any of your medication. This is the best time to address your need for refills since your doc will have you chart right there and will be able to go over your medications with you while you are still in the room. Before you leave the office, you should be presented with a print out of your care plan or a summary of the visit. In that care plan will be all the details of your visit including a list of your medications and any changes made. This is a valuable tool since you can take it home and refer to it as needed.
  1. After Your Visit: If you feel like the treatment isn’t helping or you are feeling some ill effects from the treatment do not hesitate to call your physician’s office and report any adverse reactions to medication or other treatment. Below is a guideline of symptoms and when to call:
  1. Shortness of breath, itchy rash, lightheadedness, dizziness, sedation, fast heart rate ( tachycardia), heart palpations or a drop in blood pressure upon standing (orthostatic hypotension)  call your doctor immediately.  If it is after hours, go to the emergency room or urgent care as this may be a serious or life threatening complication.
  2. GI Upset, headache, fatigue. These are some of the most common side effects of medication, but they can also be related to a new or worsening illness.  If any of these are an issue for more than a few days, call the doctor’s office and let them know what’s going on.
  3. Fever: If you have been treated in the office for upper respiratory infection, urinary tract infection or are experiencing abdominal pain and develop a fever above 100.8 please call your doctor.  You should not experience fever once on antibiotics and a spike in temperature may be a sign that something else is going on.  As a caregiver, it is important to take care of yourself as well as your loved ones. It is important for you to have periodic check-ups with your physician and to address any medical issues that may come up. Caregiver’s health is the first thing to go by the wayside while taking care of someone who is suffering with a chronic illness like Alzheimer’s disease. Caregivers have a tendency to think that their well- being doesn’t matter because their loved one is more seriously ill.  If you don’t take care of yourself, then who will take care of them if you can’t?  Developing a good relationship with your family doctor is essential to receive the best care possible. Don’t be intimidated by the white coat.  Medical personnel want to help.  But they can’t do it alone.  In order to receive the health care you deserve, you have to be an active participant. If you don’t speak up for yourself, who will?

(What are some of your concerns when going to the doctor?  Comment here or email me at http://www.mariaciletti@mariaciletti.com)

[1] Frost RW, Lettieri JT, Noe A, et al. Effect of aluminum hydroxide and calcium carbonate antacids on ciprofloxacin bioavailability. Clin Pharmacol Ther. 1989a;45:165.  Cited 12/23/2014

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Blog: Gratitude: The Healing Attitude

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more.  It turns denial into acceptance, chaos into order, confusion into clarity.  It turns problems into gifts, failures into successes, the unexpected into perfect timing, and mistakes into important events.  Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.” – Melody Beattie 

 I saw the above quote on the website, http://www.Caregivingwithapurpose.com. I have been a long time fan of Melody Beattie and have read many of her books. One of my favorites is The Language of Letting Go, a book of daily meditations that I found very helpful in some of the most difficult times in my life. Melody’s quote here so well describes one of the best ways to open up our lives and to help us be thankful for what we have right in front of us-today even if what’s in front of us is not what want or even asked for.

Many of us have been put into the position of caregiver by default. Many of us feel guilty because secretly, we don’t want to be in that position. It’s not that we don’t care about our loved one- we do care- very much. Many of us have put own lives on hold in order to care for those who can no longer care for themselves. The problem is that most of us have been doing this a long time and quite simply, we have run out of gas. Many of us feel we are missing out on living our own lives because of the monumental responsibilities of care giving. But the truth is that taking care of our loved one’s is a part of our life. For what ever reason, this is where we are supposed to be right now, even if it isn’t where we planned to be at this time of our life. 

 Melody’s quote reinforces that attitude is everything. Being a caregiver is hard. Lets face it, there are very few high points to it. We as caregivers can’t help but see the future as bleak because when this is over, when our care giving responsibilities are finished, our loved one will be gone. Doesn’t sound fair does it? Well, it isn’t. That is why in order to get through this difficult time, we need to change our way of thinking. Chances to feel grateful can be found almost anywhere if you look close enough. It doesn’t have to come from big revaluations or breakthroughs. I learned to be grateful when my mother safely made it though another day. I learned to be grateful when she didn’t burn the house down while she smoked her Salem cigarettes. I learned to be especially grateful when we both slept through the night. The new medicine that is helping your loved one sleep or eat better or making them more comfortable is something to be grateful for. Gratitude can be found in the fact that your loved one is still able to dress or feed them selves. Some days you might really have to look really close to find those moments of gratitude, but I assure you- they are there. Something as simple as the sound of your loved one’s laughter, the smile on their face, or a brief moment of clarity, can be all you need to turn things around. A good sense of humor helps too. 

 Dealing with any illness is a journey. Dealing with a terminal illness is a journey no one wants to take. It’s usually a journey where we know how it ends but are unsure of what will happen along the way. This can be the scariest part – the not knowing what’s going to happen day to day. This is where our change in attitude is needed the most. Instead of being hyper-vigilant and trying to fix everything that seems to be going wrong, we need to step back and look at each change in our loved one’s condition as an opportunity to understand the disease. Not only will looking at it this way help you to learn how to handle the changes better, it will teach you that sometimes what is happening is totally out of your control. Knowing what is going on and why can give you peace of mind. In a way it helps you to pick your battles, so to say, to the point where you will know what needs to be addressed and what does not. Knowing this will allow you to relax a bit and just be with your loved one when nothing else can be done. Sometimes. that is all they really need from us anyway. The opportunity to be close to your loved one and to share their journey is a gift and something you and your loved one will both be grateful for.

Dragonfly Publications
Care Tips for Dementia Caregivers

Here is a true-life example of why patient advocacy is important:
One afternoon, my mother, who at the time, because of her advanced Alzheimer’s dementia, was living in a nursing home, suddenly started vomiting large amounts of blood. The nursing home appropriately called a squad and sent her to the nearest hospital. Unfortunately the hospital they sent her to was not the same hospital where she was usually treated.
I was at work, so when the nursing home called me to let me know what happened, it took me about thirty minutes to wrap things up at work and to get to the hospital. When I got to the ER, the receptionist told me mom had arrived and was in treatment bay 1. I walked over to bay 1, a curtained area across from the nurse’s station and inside I heard someone say in a not-so-pleasant voice, “C’mon Grandma- hold still while I get this gown off of you.” Then I heard- “Oh no we are not gonna fight about this Grandma- you are gonna do what I say and we will get along just fine.” I immediately pulled back the curtain and found my mother half dressed in a blood soaked gown, crying and a nurse’ s aide struggling with her to get her out of it. The aide jumped back and seemed stunned by my abrupt entrance.
“What was going on? I asked.
“Grandma here won’t let me help her out of these messy clothes.”
“She is not your grandma,” I said (This woman calling my mother grandma seemed derogatory to me). “She’s my mother and she has dementia,” I said. I walked over to mom who was trembling. “Talking to her that way is scaring her.”
“What way? The aide said, her voice indignant. “I didn’t do anything wrong,” she said. “She just won’t do what I tell her to do.”
I couldn’t believe what I was hearing! How could this person be working in an emergency room? You can’t tell me this is the first person with dementia she has ever encountered. I took a deep breath.
“She doesn’t understand what you want her to do. You have to talk to her-slowly- softly and gently,” I said.
The aide looked at me as if I were from another planet. “Well then if you think you can do a better job- I will leave this up to you,” she said and then walked away.
I felt my face heat up with fury. My plans were to report this incompetent aide- and I would do that soon- but right now Mom needed taken care of and right now I was the only one she could count on. I got Mom calmed down, undressed and into a clean gown. Shortly after that a lab tech came in and drew several vials of blood. An hour later, mom was wheeled down to radiology for a CAT scan of her abdomen. After about a two hour wait in the ER, Mom’s lab work came back showing that she was severely anemic and in need of a blood transfusion. They still did not know where she was bleeding from because the CAT scan results were negative. Mom would need admitted to have the transfusion overnight and a GI consult was ordered to find out the source of the bleeding. Six hours went by until finally a bed became available on a general medical floor. It was after midnight by the time I got mom in her room and settled. A medical resident came in and performed a history and physical on her. He said that someone would be in to draw more lab work so they could type and cross match Mom’s blood, so they could order the blood she needed from the blood bank and then they would start the transfusion. He estimated by how low her blood count was (Normal blood count is 14 gm- Mom’s was 5 gm!) she would probably need two units of blood. I asked him when the GI doctor would be in to see her. He said probably not until the morning when he makes his rounds. This took me back a bit. Obviously mom was bleeding from somewhere- enough for her to require two units of blood. Granted she hadn’t vomited blood in the last few hours, but wasn’t it important to find out what was going on? Mom was getting weaker as the hours ticked by. At one o’clock the type and cross match bloodwork was drawn. Hopefully this would get things started.
Three o’clock- no blood transfusion. Four o’clock- no blood transfusion. Finally I went out to the nurse’s station to see what the hold- up was. The ward clerk looked up the lab results and told me they were still “pending.” As soon as the results were back someone would be in to start her transfusion. At six o’clock-the sun came up but still no blood. I went back out to the nurse’s stations where a fresh shift of nurses had just arrived. I told one of them that Mom was in room 1123 and was supposed to get a blood transfusion last night, but still had not and could she look into it. She assured me she would as soon as she got report. I never saw her again.
Mom slept off and on through the night, but now seemed more restless and was having difficulty breathing. I felt for her pulse- it was 130 and thready (weak). She was receiving two liters of oxygen through a nasal cannula, but that wasn’t doing much good as she was totally mouth breathing now. Around nine-o’clock mom’s IVAC beeped because the IV had gone dry. I let it beep hoping that someone would eventually come in and take care of it. Finally a nurse came in and hung a new bag of IV fluids and checked mom’s vitals. Her BP was 60/40.
“Does her blood pressure always run this low?” the nurse asked.
“No-her blood count is low and she was supposed to get a blood transfusion last night. Is the blood ready yet? The nurse flipped through her notes. “Looks like we are still waiting on the type and cross match,” she said.
“They drew that at one o’clock last night- how long does it take to run a goddamn lab test?” I snapped.
The nurse took a step back.
“Look, I’m sorry. I’ve been here all night. No one has so much as brought my mother a glass of water. Can you find out what is going on? She’s bleeding from somewhere and the ER doc ordered a GI consult. Can you find out when the GI doc will be here?”
“I’ll call down to the lab and find out about the blood. I don’t know when the GI doc will be in-sometime this morning I would imagine,” she said and left the room.
I dozed off in the chair next to mom’s bed but then suddenly woke to a severe pain in my neck and the nauseating smell of hospital food. I looked over at Mom. She was sleeping. Noisily breathing with her mouth wide open. I looked over at the IVAC pole-still no blood. I looked at my watch- it was noon. I had had enough.
I marched out to the nurse’s station and asked to speak to the nursing supervisor. I was told she was in a meeting.
“Ok then I want to speak to the medical director,” I said.
“Is there a problem?” the ward clerk asked.
“My mother is in room 1123. She has been in this hospital for nearly twenty-four hours. She is severely anemic-bleeding from somewhere that no one seems to care about. Her pulse is weak. Her blood pressure is low. She was supposed to have a blood transfusion last night- that never happened.”
“Ok-ok, I’ll get her nurse,” the ward clerk said.
Mom’s nurse-another nurse I had never seen before but who was now deemed “Mom’s nurse” appeared at the nurse’s station. I went through my spiel again. She said she would check on everything and let me know. I snapped- that answer might have worked last night but it wasn’t working now.
“Look–I want my mother transferred out of here,” I said. “You people obviously do not know what you are doing. And because my mother is elderly and demented you don’t think she deserves your time. I want her out of here- I want her transferred to her regular hospital and I want her out of here now.”
The nurse and the ward clerk looked at me as if I were about to take them hostage. I knew by the looks on their faces that they now saw me as a problem- an irrational, possibly dangerous, over protected family member-the hospital staffs worse nightmare! But my behavior got results. Although it took them another two hours to process the paperwork, Mom was transferred safely to her regular hospital.
The actual transfer took thirty minutes. Once at mom’s regular hospital, she was taken to the GI lab for a STAT endoscopy. There the GI doc found two huge bleeding ulcers in her stomach that he was able to cauterize. He then admitted her to a medical floor where UPON ARRIVAL to the floor she received two units of blood. After the blood transfusion, her vital signs improved. She even woke up a bit and was more alert-something we hadn’t seen in quite some time. In two days she was discharged back to the nursing home. Thankfully Mom had a good outcome. Had I not insisted that she be transferred from the previous hospital, I knew she would no longer be with us.
This is why patient advocacy is so important. Not only for our loved ones with dementia, but anyone who is ill. Whether you are taking a family member to the emergency room or you are going there for treatment yourself ALWAYS have someone there with you. Everyone needs an advocate who can speak up for them. Not all hospitals are like the first hospital Mom was admitted to. The majority of hospitals employ competent, caring staff. During Mom’s illness she received wonderful care form most of the facilities she was treated in. But there will always be one event that you need to be on the look- out for. If you see something that doesn’t seem right- speak up. This is the time to ask questions and ask for clarifications. Do not feel intimidated. Do not feel you are bothering the staff. It is your right and your loved ones right to know what is going on. Dealing with health care professionals should be comforting- not confusing. When your loved one is being treated you should feel confident that they are being treated right. If you don’t speak up, the consequences can be devastating.

A good advocate needs to be assertive and have good communication skills. This is especially important when dealing with new health care providers that do not know your loved one or their history. Every medical event requires you as advocate to pay close attention to new symptoms as well as new treatment and medications ordered. Granted medical staff are human and humans make mistakes- trust me- I have seen it happen. There will be times when things just don’t seem right. This is when you will need to speak up. If you are not getting the answers you need- leave. Take your loved one to another facility for treatment. It is better to be safe than sorry later. If you don’t act- it could mean your loved ones life.