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The 2012 Elections and the Issue of Healthcare Reform

This column first appeared
in the Syracuse Post Standard
January 17, 2012

During both the 2008 and 2010 elections, the issue of reforming the American healthcare system was the focus of overwhelming amounts of misinformation and disinformation.

Remember the email about Senior Death Panels?  It explained that the healthcare reform bill would allow Medicare to save money by refusing to pay for lifesaving treatment for older Americans.  Of course, it wasn’t true.

Another email stated that the Muslim belief in dhimmitude (surrender or appeasement) would mean American Muslims would be allowed to opt-out of the mandatory insurance rule. Also untrue.

Both inflammatory statements were horribly upsetting!  But it wasn’t a huge leap to figure out who wanted us to believe them.

Now primary season is here again, and some candidates continue to focus on repealing the Affordable Care Act (healthcare reform).  Whether or not you believe healthcare reform should be the law of the land, you owe it to yourself, and those you influence, to separate facts from fiction.

If someone shares “facts” with you that seem inflammatory, upsetting or don’t make sense, then there may be something askew. It’s possible they are true. Or, they may be only partially true, subjective interpretations of the truth, or even out-and-out lies.

Three websites provide neutral, objective analyses of political statements for our review. The best way to determine the veracity of information about healthcare reform, or any other political statements, is to scrutinize them at one, two or all three sites.

One site is the Pulitzer Prize winning Politifact.com. Its “Truth-o-Meter” scores statements on a range from True, to Flip-Flop, to Pants-on-Fire, along with supporting documentation for how the score was determined.

Factcheck.org is provided by the Annenberg Public Policy Center.  One section focuses specifically on email rumors.  Another section examines statements made by candidates and their high-profile supporters  to establish their accuracy.

Finally, Snopes.com is a great resource, too. While it originally examined only urban legends, in recent years it has expanded into political claims as well.

If you see, hear or read a statement from any organization or individual during the election season or any other time, be sure to review it carefully before you share it with someone else.  You don’t want to foolishly believe things that aren’t true, nor do you want to share misinformation or disinformation with others.  Using one of these statement-auditing websites will help you sort out the real facts.

Here is more information about reviewing email claims:

 How to Confirm or Debunk Claims
Made in Email, Blogs or Social Media

From Conspiracy Theories to Bogus Claims
How Can You Ascertain the Truth?

Have you confirmed or debunked a political email claim?
Share your findings!

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Advocating – What’s “Friendly” Got to Do With It?

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It’s a simple question, but it has stirred some controversy.  It’s the word “friendly.”

Colleague and fellow passionate advocate Bart Windrum got (as my mother would say) his blood in a bubble after reading an article about engaging a patient advocate to help you navigate your healthcare, recently published in a Tampa newspaper.

In a list of tips about how to advocate for someone else, one tip said, “In hospitals ask, in a friendly way, that every pill, every injection, ….”

Bart thinks that’s ridiculous. He believes “friendly” comes across as “Beg. Acquiesce. Place yourself beneath again, some more.”

Bart is an author of  Notes from the Waiting Room. He knows what he is talking about.  Bart suggests we be business-like.  I agree.

Business-like may be a term lost on some who don’t operate in a business environment.  So I call it commanding respect.  To gain respect, which is so necessary in any medical setting, you must command it. You earn it by your actions and approach.

(Please note — that does not say “demand respect” — I believe that is impossible in any medical setting unless the other person fears you — another post for another day.)

How will you command that respect?  By being diplomatic and concise.  Start with polite. Let them know you have specific expectations and want accurate information. Earn / command the respect of those who can get you what you (your patient) needs.  If you don’t get the information or action you need in a fair amount of time (some actions require seconds or minutes, others can wait a half hour) then become assertive.  Never, ever become aggressive unless it is life and death and you are being ignored.

Here’s an example I got from Charles Inlander, a gentleman who was advocating for patients before most realized they needed it.  He was in the hospital, and needed a nurse’s help in the middle of the night.  He pushed the call button a number of times and got no response. (Does THAT sound familiar!) So finally he picked up the hospital phone, dialed “O” to get the operator, asked for the nurses’ station on his floor, told the person who answered what need needed, and seconds later the nurse showed up in his room.  (I love these kinds of ideas!)

What’s your experience?   Have you advocated for a loved one in a hospital?  Did “friendly” work when you actually needed something? Or did you find yourself having to be more definite and concise?

Did you command respect?

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More Infection Warnings – Tools to Prevent Germy Spread

Betsy McCaughey, director of RID (Reduce Hospital Deaths) reminds us in her latest Wall Street Journal article that those hospital germs, the ones that cause death and debilitation, are everywhere.

In her most recent article, she points to doctors’ and nurses’ scrubs, coats, ties — their clothing.  MRSA, C.Diff. and other infectious pathogens cling to the fabric and get passed from patient to patient.

So — imagine that for a moment — the doctor brushes you with his white coat, that very item that represents his/her MD-dom — and passes an infection on to you which will make you very, very sick, or even kill you.

From Dr. McCaughey’s article:

The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus. Doctors’ lab coats are probably the dirtiest. At the University of Maryland, 65% of medical personnel confess they change their lab coat less than once a week, though they know it’s contaminated. Fifteen percent admit they change it less than once a month. Superbugs such as staph can live on these polyester coats for up to 56 days.

Do unclean uniforms endanger patients? Absolutely. Health-care workers habitually touch their own uniforms. Studies confirm that the more bacteria found on surfaces touched often by doctors and nurses, the higher the risk that these bacteria will be carried to the patient and cause infection.

According to Dr. McCaughey, hospitals used to provide laundered uniforms and scrubs to their personnel, but that practice has gone by the wayside.

So, it seems like it would be a good practice to bring back.  Especially since Medicare is no longer paying for care for patients who acquire infections in the hospital, it seems that laundering that clothing would be far less expensive than having to eat the cost of caring for so many infected patients.

Today’s second warning comes from Bottom Line Health, one of my favorite publications.  I like Bottom Line because it doesn’t accept advertising, and it always brings in multiple points of view, e.g. the best of Eastern and Western medicine and ideas.

This notation comes from Jean-Yves Maillard, PhD from Cardiff University in Wales, UK who tells us that those disinfectant wipes we use on surfaces to kill bacteria (think clorox wipes, or those wipes they put near the shopping carts at supermarkets) may actually just spread those germs around.  We may not be killing those buggers at all!  Dr. Maillard suggests instead that we use one wipe per surface — or one swipe per wipe.

When it comes to these killer germs, we patients just can’t be too careful, can we?

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Never Events — Shooting the Messenger

Beginning October 1, 2008, Medicare, and many health insurance companies, will no longer pay hospitals for the additional services needed for patients who suffer from “never events.”

Never Events, as defined by the National Quality Forum, are those events which should never happen to a patient.  There are 28 errors on the list ranging from wrong site surgeries to drug errors to crimes committed by medical professionals.

Not included on the list from the NQF are HAIs (hospital-acquired infections).  There may be many reasons for this, but there are many groups and organizations that believe HAIs like MRSA, C.Diff and VRE SHOULD be included on the list.  Many of them, although not all of them, are preventable.

Regardless of what the left hand is doing (NQF), the right hand of payers (Medicare and many insurers) have decided that these infections will no longer be covered.  That means that any hospitalized patient who contracts, or at least presents with, an infection during a hospital stay may not be charged for the extra cost of treating the infection, nor will the hospital be paid by Medicare or many of the health insurance companies.

I don’t have the expertise to say whether this is right or wrong.  On the one hand, I believe it’s absolutely necessary to force hospitals to figure out ways to decrease the numbers of patients who contract these infections, estimated to be upwards of 5 million patients per year.

On the other hand, I know that sometimes patients arrive with pre-existing infections that may be apparent when they are admitted.  Can they be tested upon arrival?  Of course they can — although some hospital personnel point out how expensive that is, and that insurance won’t cover that either.  I have no doubt that there will be some problem for patients that crops up from this new ruling.  Hospitals will refuse to admit patients at risk, or they will discharge them too early so they can — at least in the paperwork — ignore an infection just as it begins.  Hospitals will do whatever they need to to protect their *sses — and it will be at the expense of patients.  Unintended consequences, all based on money.  What else is new?

During the past few days, a dialogue has taken place… wait… make that a diatribe…. on the blog of a certain “buckeye surgeon” where complaints and barbs have been thrown at a newspaper reporter who wrote about this October 1 date for reimbursement stoppage.  On just about the same day, the Wall Street Journal printed an article by Dr. Betsy McCaughey, founder of RID (Reduce Hospital Deaths) that gave some statistics about hospitals that have addressed infection problems — and have successfully reduced their numbers, one (claims) to 0 patients over a span of years.

So –I pulled some quotes from Dr. McCaughey’s WSJ article and posted them to the blog — and you would have thought I was the devil-incarnate…. whoa!  A regular lightening rod!  All those doctors so quickly turned their ire on me.  And I thought angry patients got worked up!  They can’t hold a candle to posters like “white coat” and “anonymous” who — God forbid — don’t even use their real names.

No — they attacked me one after the next.  In fact, it began when I suggested that SOME hospitals were actually trying to help patients!  SOME hospitals are actually asking their doctors and personnel to adhere to a checklist that — (you won’t believe this) — actually prevents infection!

Oh — one even attacked me for not being grateful that I was misdiagnosed with cancer.  She told me I should not have been upset at the misdiagnosis — I should have been relieved that I didn’t have it.  (My standard reply, which I didn’t bother with is — “gee — you didn’t get hit by a car today.  Are you relieved and grateful?”)  Of course — what on EARTH does this have to do with infections?  I’m not sure.

What’s the bottom line?  What can we learn from this?  Honestly — I do NOT believe that including HAIs on the list of never events Medicare and some insurances will no longer pay for was the right approach.  While some infections could have been listed and it would have been helpful, instead I think Medicare has only thrown down the gauntlet for hospitals to go underground.  Patients will pay the price in even worse health problems.  We must be more vigilant and be prepared to stand up for ourselves and our loved ones, and once October 1 rolls around, that will be even more difficult.

What the Trisha-bashing on the Buckeye Surgeon’s blog has shown me is that when we patients begin to stand up for our NEED for decent healthcare, we become the enemy.  The point I tried to make on a couple of the blog posts was that I think patients and providers need to remember that we have the same goal — improved patient care.  But those folks didn’t want to go there.  They just wanted to bash me.

I pray none of them is ever hurt by a medical error.  I hope none of them ever suffers at the hands of a medical practitioner who is probably just in a big hurry because he doesn’t get reimbursed well enough for his work.  I hope they don’t lose a loved one, like I did, after she acquires MRSA.

But mostly I hope they will stop taking their frustration out on the messenger.  Afterall — excuse me — I THOUGHT we all had the same goal?

Don’t we?

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When Egos Transcend Common Sense and Doing the Right Thing

I’ve been reminded twice in the last two days about the oncologist who was a part of my misdiagnosis story. He’s a big part of it; if he hadn’t been such an arrogant SOB, then I probably would not have changed careers to help other patients help themselves.

But most days I don’t even think about him. So two reminders in two days? That’s a double whammy.

The first came yesterday as I participated in the Susan G. Komen breast cancer Race for the Cure. There were almost 8,000 participants, among them several hundred breast cancer survivors. I had the opportunity to speak to a handful of them, and when they were particularly happy about how successful their treatment was, i would ask them who their doctors were.

One woman shared a litany of doctor’s names, among them was the same oncologist I had dealt with. She spoke in glowing terms about all the other doctors, but his name was just a part of the list. Nothing good to say — he was just a participant.

I didn’t comment. I didn’t ask her about her experience with him. I have never shared his name publicly because my goal has never to cast dispersions on him personally. I will confess, however, that if someone is seeking a new oncologist for a second opinion, or for referral purposes, and they have told me he is under consideration, then yes — I have shared my experience. Have I had an influence on which patients have chosen to see him? Yes, I’m sure I have — but not much of one.

Then this morning, I found this article from the New York Times, entitled, “Doctor’s Start to Say ‘I’m Sorry’ Long Before ‘See You in Court.’ And there it is again — that feeling…. argh. He held my life in his hands, and he was so ready to treat me with deadly chemicals for no reason….

One aspect of my dealings with him continues to confound me. He never apologized.

Once my misdiagnosis was proven by the National Institutes of Health, I contacted all the doctors who had participated in the odyssey. Of those who had made mistakes and contributed to the errors, I asked for apologies. I made it clear I was not interested in lawsuits.

All the doctors who had contributed to the mistakes apologized — except the oncologist. In fact, he sent me a long letter outlining why he had done the right things. Never mind the fact that he had never read the results of lab tests indicating one more test was being run — yet he had never looked at the results. Never mind the fact that when I told him I wanted another opinion, his answer to me was “what you have is so rare, no one will know anymore about it than I do!”

There is much in the medical literature these days about the positive outcomes when doctors own up to the mistakes they’ve made. This article from the NY Times is one example. Patients heal better, fewer lawsuits are filed, there are so very many aspects of improved health and service that come as a result of professionals taking responsibility.

It’s too bad for this particular doctor that his ego won’t allow him to do the right thing. On the other hand — had he been more forthcoming, perhaps I would not have been angry enough to make sure these kinds of problems wouldn’t happen to other patients?

We’ll never know. But I sure as heck hope that, as time goes on, he’ll realize his ego is getting in the way of his competency. A good doctor is a decent human being, too. In my opinion? Until he learns to own up to mistakes, he’s not much of doctor.

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