Patients Are Powerful

Talking to a doctor (when you’re a patient in an exam room) isn’t easy. I’m not talking about those fleeting moments when you suspect the doctor of having “God-complex” issues that make you feel as if you won’t be heard unless you genuflect or get down on both knees. No, what I’m referring to is when you’re standing barefoot or sitting bare-bottomed wearing a paper gown, with florescent lights beaming down on you making you look even less healthy than you already feel. Under these awkward and embarrassing circumstances, with the doctor fully dressed and sporting the all-wise, highly-achieved white coat, while you’re lacking even the basic outer accouterments that might give a modicum of self-confidence, it’s pretty hard for you to get your thoughts in order and feel your patient power. Instead, when it comes to your asking questions about your health, medical condition, and treatment, you feel uncomfortable, anxious, and ineffective. The “power gap” is almost palpable!

It is uplifting to take note that, in the last decade, some medical schools have started trying to bridge this gap by teaching their med students “clinical communication skills.” Third-year and fourth-year students are actually being required to role play, i.e., face-to-face encounters with actors playing patients of varying ages with a variety of dispositions and diseases. The students are then tested to see how well they interview “patients,” conduct physical examinations, and convey exam findings to the patients. Obviously, their ability to be empathetic is a big plus.

The good news is that this type of training doesn’t stop after graduation. In fact, in March 2005, the Communication Skills Laboratory at Memorial Sloan-Kettering Cancer Center began offering a series of three-hour interactive workshops intended to give hospital oncology residents practice in “Breaking Bad News,” “Discussing Prognosis” and “Responding to Patient Anger,” among other touchy health-related topics.

Still, with all the emphasis on a doctor’s communication with patients, the patient advocacy side of the problem has largely been neglected. For instance, where are the guidelines for patients, such as “how to” or “when to” raise important questions that will help to calm the psyche without alienating the very person who may end up standing over them with a scalpel in his or her hand?

Unfortunately, the number of appointments (confrontations?) that require a negotiation between the doctor and the patient seemed to be on the rise, while the amount of time spent with a patient during a medical visit seems to be on the decline. How does a patient get the answers they need from their doctor, or how do they respectfully disagree?

A patient advocate is invaluable when it comes to helping patients prioritize the questions that are most pressing. Studies have shown that often the most important symptom or worry that a patient may have, such as a suspicious mole or lump, or even the feeling that life isn’t worth living, is often not on the top of a patient’s list, and such questions are frequently blurted out at the very end of an appointment because the patient was either afraid to ask the question or didn’t know how to prioritize it in the framework of a typical medical exam. In these instances, patients who have a patient advocate by their side can feel more confidant and be more assertive when requesting a follow-up meeting.

So, in this current healthcare climate, even when doctors are taught to listen attentively to patients, they are also well-aware that with low insurance reimbursements such attention comes time-constraints attached. The more a prepared a patient can be prior to a scheduled appointment with their doctor, with a list of prioritized questions in hand, the more patient power they will have.

Technorati Tags: patient advocate, patient power, patient-doctor encounters, patient-doctor power gap

As a Chicago chiropractor, I wait anxiously along with my patients and the rest of the country for the passing of a new comprehensive and compassionate Health Care Bill. And, along with the questions of cost and inclusiveness that everyone is asking, I believe that we should also be asking if an overhaul of the U.S. heathcare system will include simplification? Let’s face it, our current system is not only horribly expensive and amazingly ineffective, it is inherently complicated. When a person is ill, and may be in need of surgery or recovering from it, the last thing that they should have to worry about are complex insurance issues, sorting through mountains of bills, making certain that the proper medications are given, and that appropriate arrangements for follow-up treatment are made. Thanks to the dedicated patient advocate, these questions often do get answered.

However, if the new Health Bill falls short of simplification, as most Congressional Bills tend to do, through patient advocacy, patients will still have the “extra strength” they’ll need in order to stay informed when talking to the doctors, in getting to see a desired specialist, in ensuring that the pills that they are given are the ones meant for them, and, if necessary, in negotiating for any additional help that they may require and the fees charged for the services.

This is just part of the great service that patient advocates provide today. And, I suspect that no matter what happens to the healthcare system in the future, with the scores of aging baby boomers demanding, as they should, to receive the proper and affordable health care they require, the patient advocate will still be a vital part of any health environment.

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Chiropractors, like me, often find that one of their patients is a caregiver to a family member who is suffering from a progressive disease. And, frequently, that disease is cancer. Family caregivers are truly the dearest of all patient advocates, and sometimes they feel helpless in easing the pain of their loved one. So I was very interested in a study, sponsored by the National Cancer Institute that found that family caregivers can significantly reduce the suffering of a family member who has cancer, through the use of simple touch and massage techniques.

Ninety-seven multi-ethnic cancer patients were chosen and they represented 21 types of cancer (nearly half with breast cancer) and all stages of disease. The caregivers included spouses, adult children, parents, siblings and friends. Researchers evaluated the outcomes of a 78 minute DVD instructional program and illustrated manual shown to the patients and their caregivers.

Caregivers in the experimental group were asked to apply the instruction for at least 20 minutes, three or more times per week for a month. Caregivers in the control group were assigned to read to the patient for the same amounts of time. Patients completed report cards before and after sessions rating their levels of pain, fatigue, stress/anxiety, nausea, depression, and other symptoms.

Companionship alone had a positive effect as the results showed significant reductions for all symptoms after both activities. But, even though symptoms were reduced from 12-28 percent after reading, massage from a caregiver led to reductions of 29-44 percent. The greatest impact was on stress/anxiety with a 44 reduction. This was followed by a 34% decrease in pain, a 32 percent decrease in fatigue, a 31 percent reduction in depression, and a 29 percent reduction in nausea. In addition, caregivers in the massage group showed gains in confidence and comfort with using touch and massage as forms of caregiving.

“Touch and massage are among the most effective forms of supportive care in cancer, but most patients cannot access professional practitioners of these methods on a regular basis,” said principal investigator, William Collinge, PhD, president of Collinge and Associates. “It appears that family members who receive simple instruction in safety and techniques can achieve some of the same results as professional practitioners. This has important implications not just for patient well-being, but for caregivers as well. Caregivers are at risk of distress themselves. They can feel helpless and frustrated when seeing a loved one suffer. This gives a way to make a difference for the patient, and at the same time increase their own satisfaction and effectiveness as a caregiver. It also appears to strengthen the relationship bond, which is important to both.”

The DVD program is now released to the public, titled “Touch, Caring and Cancer: Simple Instruction for Family and Friends,” in English, Spanish and Chinese. More information and video trailers are available at http://www.partnersinhealing.net.

Technorati Tags: cancer, family caregiver, research, touch and massage

As a chiropractor and a passionate healthy lifestyle advocate, high on the “health do to list” that I give to my chiropractic patients, young or old, is to stop smoking! And, though I know from experience that patients are powerful when supported and encouraged, I also know that different people respond to different stimulus, especially when they are trying to give up an insidious habit like smoking cigarettes. So, I was particularly happy to read on Discovery News (link below) about a virtual reality video “game” that, according to a new study published by the journal Cyberpsychology and Behavior will help people to stop smoking. I’d never really considered a video game to work so impressively as a patient advocate.

Researchers from Canada’s GRAP Occupational Psychology Clinic and the University of Quebec in Gatineau divided 91 smokers into two groups and enrolled them in a 12-week anti-smoking support program. In addition, each group played a specially designed video game four times a week. After entering a computer-generated virtual environment, one group of participants chased down floating cigarettes and crushed them while the other group crushed floating balls.

The study’s findings showed significant reduction in nicotine cravings among smokers in the cigarette-crushing group. At week 12, 15 percent of the cigarette crushers had abstained from smoking, compared to just 2 percent among the control group. During a six-month follow-up, while 20 percent of  ball crushers reported not smoking during the previous week, that rate reached 39 percent among the cigarette-crushing group.

The researchers were unsure as to why the cigarette crushers’ had a higher success rate, but they speculated that the virtual exercise may have further motivated their meeting attendance, as well as boosted motivation to quit smoking and increased confidence in the ability to kick the habit. The game also may have provided participants with positive associations to fight off urges, i.e., crushing cigarettes in the virtual reality environment may have conditioned smokers to resist their urge to light up.

For more on the study and a link to the GRAP’s study, visit Discovery News

Technorati Tags: GRAP, stop smoking, virtual reality video game

My chiropractic clinic is right next door to a veterinary clinic. The clinic, run by two veterinarians who are husband and wife, is very popular in town. I, personally, like the fact that the veterinarians take a holistic approach to treating their animal patients. But, what I like best is the big, furry Burmese cat that “owns” the clinic. She basks in the sunshine that streams into the two front offices and whenever I walk by, she gives me her full attention. If I put my hands on the outside of the window, she rubs her body against the glass as if she can actually feel me petting her. And, though I can’t actually hear her, I’ve always suspected that she’s purring peacefully on the other side. I have to say that I feel instantly happier after our little encounters. I had a cat companion for nineteen years, and since her passing last year, I have found that even though I do yoga and meditation, “Hazel” was the best stress reducer in my life.

As a chiropractor I am always looking for natural, drug-free approaches to health, and I can’t think of anything more naturally healthy than having a pet (as long as a person doesn’t suffer from allergies, of course!). You could say that pets are very similar to patient advocates. They are genuinely happy to see you, they offer unconditional attention and affection, and their goal is to help you to feel better, even if it is just to sit with you when you need companionship.

Many studies have shown that having a pet can actually help to control blood pressure. One such study compared a group of hypertensive patients that owned pets with another group that did not. While both groups remained on blood pressure medications, the  dog and cat owners were less likely to experience spikes in blood pressure and heart rate due to tension and stress.

Pets have also been shown to be helpful for people who tend to suffer from depression or anxiety. After all, it’s human nature to feel less sad or anxious, no matter whatever else may be going on, when a cat rubs up against you and purrs, or a dog looks adoringly in your eyes as if you are truly someone special. And, just as their human counterparts are able to help patients who are having a hard time dealing with an illness, pets have been shown to be helpful, too.  Researchers have found that people who have been diagnosed with difficult diseases are more able to cope with their situation when they are in constant contact with a pet.

So, if you’ve been feeling “down in the dumps,” a furry patient advocate may be able to help. In that case, an animal shelter may have just what you need!

Technorati Tags: anxiety, blood pressure control, depression, dogs and cats, pets, stress reduction

Are you  “too happy” to be a patient advocate? Is your “positive attitude” a detriment to the very people you long to help? As a chiropractor who finds joy and laughter a powerful healing elixir in my chiropractic clinic, my answer would be “Of course you’re not. You’re perfect for the position!” But, according to best-selling author, Barbara Ehrenreich, in her new book “Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America,” there’s just too much “positive thinking” out there, especially when it comes to a patient’s health. Wow! What a concept!

Technorati Tags: healing, health, positive attitude

Most people have not heard of the Bone and Joint Decade, but it’s an important and valuable organization sanctioned by the United Nations/World Health Organization that deserves more recognition. As a chiropractor, I have been aware of it for several years now. It is an international collaborative movement whose mission is to improve the quality of life for people with musculoskeletal conditions and to advance the understanding, prevention and treatment of these conditions. The organization if open to a variety of traditional and alternative methods of prevention and treatment, including chiropractic, and is highly supportive of the role of the patient advocate. In that regard, the United States Bone and Joint Decade (USBJD) begins its exceptional program for its 2009 Global Network Conference to be held in Washington, D.C., starting today through Saturday, October 21-24. The conference will bring together the official Bone and Joint Decade National Action Network (NAN) representatives from 56 countries, members of the administration, government policymakers, health care providers, patients, and patient advocates for a two-day Patient Advocacy Meeting and a two-day Global Network Conference. Featured program participants include Sens. Chuck Grassley (R-Iowa) and John Barrasso (R-Wyo.), Congressmen Charles Rangel (D-N.Y.), Dave Camp (R-Mich.), and Charlie Melancon (D-La.), and Colin Carrie, Parliamentary Secretary for Health of Canada.

The Global Network Conference is an education and strategic planning meeting intended to highlight the significant burden of disease posed by musculoskeletal conditions and why raising awareness and engaging in advocacy are important means of advancing prevention and treatment. On October 22, there will be a focus on raising awareness of musculoskeletal conditions on Capitol Hill for U.S. delegates, patients, and the leadership of USBJD participating organizations.

Among our successes, The United States Bone and Joint Decade includes among its successes the development of programs around osteoporosis and arthritis that have been presented to more than 200 audiences, as well as a grant mentoring program that has seen their graduates receive more than $20 million in research funding.

For more information, visit www.usbjd

Technorati Tags: arthritis, musculoskeletal conditions, osteoporosis, US Bone and Joint Decade

Did you know that nurses have acted as patient advocates for over one hundred years? You did if you’ve ever been hospitalized. Nurses are like angels without the wings (though I’ve suspected that a few nurses I’ve met over the years probably had them tucked modestly under their uniforms.) As a chiropractor I often send my patients to the local hospital for x-rays, blood work, and other tests when necessary and the nurses are always helpful, thorough, efficient, and friendly. But, it isn’t until a person is hospitalized, i.e., confined to a hospital bed, confronted with the often perfunctory, cool attitudes of doctors, and often feeling confused, frightened, and alone, that a nurse seems most like an angel. But, nurses have lot of other duties to perform as well, and so I’ve always appreciated the presence of a Patient Advocate whose primary focus was not only helping a patient “get through” the ordeal, but to answer the many questions that patients often have about medical procedures and medications, and medical records and insurance forms.

A structured, expanded, independent form of Patient Advocacy has been taking root for decades now, with programs all over the country that offer professional certification and degrees in Healthcare Advocacy. Today, Patient Advocacy is a fast-growing, and much needed profession, especially with the many changes in health care that are happening now and will, no doubt, be occurring in the future.

That’s why I was happy to read that Hiring A Patient Advocate has started the First National Registry of Patient Advocates and Patients. It’s a wonderful idea whose time has come! Patients are never more powerful than when that have a Patient Advocate by their side!

To find out more about what a Patient Advocate does, go to http://hiringapatientadvocate.blogspot.com/2009/10/what-can-patient-advocate-do.htm, or if you’d like to be part of the registry, click on http://hiringapatientadvocate.com/

Technorati Tags: Hiring a Patient Advocate, nurses, patient advocate

Have you heard the term, “anesthesia awareness”? If so, do you know what it means? I thought that I did, but today I became more “enlightened.” Anesthesia awareness is a very real phenomenon of being left fully awake and aware, yet completely paralyzed, during general anesthesia surgery. As a chiropractor, naturally I’d heard the term before and assumed that it only occurred rarely. But, today I read that it happens to 100-200 people per day in the US alone! That is a shocking figure! The good news is that there is a dedicated patient advocate who, through the Anesthesia Awareness Campaign (a nonprofit patient advocacy organization), works with victims of anesthesia awareness, tries to consummate change in the anesthesia system, endeavors to make the public “aware of awareness,” and advocates for the use of brain activity monitors in every general anesthesia surgery.

For almost twelve years, Carol Weihrer has been working to educate medical professionals and the public, as well as conducting patient outreach and support. What inspired this kind of commitment? Anesthesia awareness happened to Carol Weihrer during a 5½-hour surgery to remove her eye. Immediately after her experience, Ms. Weihrer, working alone, found a mission in life to find ways to prevent and treat this “terror of all terrors.” The result was the founding of The Anesthesia Awareness Campaign.

For more information on anesthesia awareness, please visit www.anesthesiaawareness.com.

Technorati Tags: anesthesia awareness, Anesthesia Awareness Campaign, Carol Weihrer

If you’ve never visited the Kalaupapa peninsula on Molokai, it’s an experience you won’t forget. I had a chiropractic practice on Oahu for nearly ten years before I visited the island. I can attest to its beauty. The Kalaupapa peninsula is one of the most beautiful places on the planet. It’s surrounded by the ocean, of course, and the highest sea cliffs in the world. But its beauty is not what will stay in your mind and heart once you’ve been there. What you will take away is the story of Father Damien, one of the greatest “patient advocates” who ever lived.

In the 1880’s there was no treatment for Hansen’s disease, also known as leprosy. People who had the disease were taken from their homes and exiled on the isolated peninsula of Kalaupapa, which was only accessible by boat. They were treated as outcasts until a Belgian priest, Father Damien, arrived to care for them. He eventually contracted the disease himself and died.

On Oct. 11th, he will be canonized as a saint, and some of the last remaining Kalaupapa residents are in Rome for the ceremony.

There have been several books written about Father Damien. But, a brief account of his life, along with photos, and more information on his canonization can be found at: voanews.com

Technorati Tags: Father Damien, Hansen's Disease, leprosy, sainthood