I am so very proud of the man my husband became from that service! He lived in five countries across the globe, and saw parts of life on this planet that most of us will never experience or even know about. His understanding of people and cultures, no matter where or how they live, is broad and respectful. He retains a handful of friendships with his fellow service members even these many years later.

So how do you show the veteran you love, just how much you love him? Why not make sure he or she stays as healthy as possible?

Make an appointment for you, and the veteran you love, to get a flu shot!

Even if you don’t know a veteran, even if you think you aren’t at risk of getting the flu yourself, understanding the concept of “herd immunity” will help you understand why your flu shot is so vitally important.

Learn more about herd immunity – and why Veteran’s Day is a great time to make plans for your flu vaccination.

You may save a life, whether it belongs to you or a veteran or someone else you care about.

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

De-cancered — a good word, isn’t it?  Look at these two faces — they look quite healthy, don’t you think?

Well — they most certainly are — quite healthy, despite the chemo both faced prior to proving neither one had the cancer she was diagnosed with.

What this photo doesn’t show, is the emotion behind it.  In fact, I have trouble looking at our smiling faces without choking up. That’s Heather on the right — the young woman who contacted me last June to tell me she had been diagnosed with the same rare lymphoma I had been misdiagnosed with.  We proved the professionals were wrong — Heather had no cancer at all.

And that’s me on the left — I was just so happy to meet my very healthy friend Heather and see for myself, in person, that she’s doing so well!

We met for the first time last week in Las Vegas, not far from where Heather lives, and actually quite far from my home in NY.  I was there to attend an About.com conference – but we made time to see each other.  And it was the very best “event” that took place during the entire visit to Nevada.

My hope for you is that you, too, will take the time to learn everything you can about a diagnosis you’ve been handed — it may be correct, or it may not.  I promise you that if either Heather OR I (or Daniel, who was also misdiagnosed this summer) had believed the professionals, despite our intuition and proof to the contrary, we would not have been able to meet each other, we would not be healthy today — and we would not be here trying to inspire you to better and more successful medical outcomes.

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

I had a routine colonoscopy, then 5 days later, I began to hemorrhage and passed out on the street corner. Some passerbys helped me and called an ambulance, but I ended up in the St XXX’s ER, one of the 9 circles of hell. I had a second hemorrhage there and was hospitalized for 3 days…

The St XXX’s ER was so horrible – you should have a permanent station there! I was tucked away in a corner room alone. I was on a monitor and I began to feel bad – my blood pressure dropped dramatically (30 points) and I called out for a nurse. Someone was passing by and he said he’d be right back. He never returned and I was by myself for another 20 min – at which point, I realized that being good wasn’t going to cut it and I needed to be assertive.

I started shouting and some staff showed up. One woman was trying to draw blood from my hand, but I was shaking so bad (probably from the shock) that she couldn’t fine a vein, so she just kept poking me while I sobbed. She never looked at me, but instead carried on a conversation with someone outside the room about celebrity gossip.

The ER was also filthy – I saw so many violations of sanitary standards.

On a better note, the GI Attending was a great doctor and once I got to the ICU, the care improved dramatically.

It had taken me years to get up the nerve to have a routine colonoscopy – it’s rather ironic that I did this for my “good health” and ended up in the hospital.

I have nothing to add to this except to suggest you take a page from Susan’s book. BE ASSERTIVE if things are not going the way you think they should. Be the squeaky wheel!

Thanks for sharing, Susan.  You have provided someone else with what they need to advocate for themselves in a similar situation.

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

We all think we know what healthcare reform means — we think it means something about universal healthcare, right?

You might be surprised to learn that “universal healthcare” isn’t what it’s about at all.  It’s about shifting who gets healthcare, figuring out how to pay for it, and knowing that any success we find will be based on how we ration care.

Huh?

Yes — you read that right.

Universal healthcare — it’s terminology used to confuse, actually.  Most people think it means we would move to a single payer system, but that’s not what it means at all.  Read more about what universal healthcare means here.

Rationing?  Yes — our care is rationed now.  Sometimes we are the ones who ration it for ourselves, and sometimes our insurers or the government rations for us.  You need to understand it if you really want to ‘get’ reform — because the more reform, the more rationing.

Questions?  Let me know — because your questions are what helps me write material to provide answers.  blog - at - epadvocate.com

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

Do we as individuals believe we should all have a right to healthcare coverage, similar to the way we have police protection, or fire protection, or education, or even library books?

Or should healthcare be looked at more as an individual responsibility, one we must pay for ourselves, such as food or shelter?

You still have time to vote if you wish — right here.

But the next question has now popped up:  are we so frustrated by trying to understand where the economy is going, how it tanked, and what the bailout means that we will now rest our voting decisions on healthcare reform?

Come on over to about.com and let us know what you think!

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

As you may know, the number of uninsured Americans is typically quoted at 47 million. We learned that last year those numbers were reduced to 45.7 million– not because more Americans can now afford insurance; rather, because their income had declined to levels that made them eligible for state healthcare assistance programs.

But in thinking that through, I realized there is a ripple effect, too. With the tanking of the economy comes layoffs, and with layoffs come even more people whose income will decline and, of course, that means they may not be able to access healthcare. Not all will become eligible for care through the government. In many cases, they will simply be left off the healthcare roles — no more coverage for them will mean no healthcare at all. Not for them. Not for their children either.

Which then led to another thought. The Commonwealth Fund reported in January that 101,000 people died last year from problems that would have been prevented if the person who died had health insurance. Do the math. 101,000 deaths. 45.7 million uninsured. That’s 22 uninsured people who died for each million who didn’t have insurance.

Now let’s look at what’s beginning to take place as a result of those greedy Wall Street CEOs who have caused our economy to decline, and who will be responsible for millions more job losses. For each million people who lose their health insurance because they’ve lost their jobs, 22 will die.

In my not-so-humble opinion — that’s blood on the hands of those Wall Street criminals and robber barons who have reaped millions of dollars for themselves, while denying the rest of the world its stability. This isn’t about people jumping off buildings and bridges because they’ve lost their savings. This is about people — responsible and hardworking Americans — who will no longer be able to pay for the care they need, have earned, and deserve.

Maybe those very guilty CEOs can’t be arrested for bad business dealings. But certainly they should pay for the deaths they will cause?  And what about the families left with no one to support them because their loved one has died?

These dominoes are huge and destructive.

	Want more tools and commentary for wise patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

Point-of-view is always a good place to begin.  Understanding the point of view of whatever it is that stands in your way can help you figure out how to get beyond it.  Here’s an example:

A Medical Center is Not a Hospital

Written by Thomas Lansdale III, MD, an internist with several decades of experience working in hospitals at first — which evolved to “medical centers” — he compares the experiences of those early decades of his work to the experiences of today.

His comparison is the doctor’s point of view.  It’s not about the money parts, although the money pursuit is certainly the basis for why the shifts have taken place .  It’s about his ability to enjoy the fruits of his labor.  In the early days, a patient stayed in the hospital long enough to do much of his healing.  Now, patients are ejected the moment their procedure is past.  Then, Dr. Lansdale could teach his medical students and enjoy their “aha!” moments.  Today, those students have had to become more robotic.  They can’t take the time to revel in the “ahas” — because they must complete their work on so many more patients in a day.

How can we patients use this information?  We need to understand that our doctors, nurses and other providers are just as frustrated, and perhaps even more so, than we are.  A nurse who early in her career was helping bathe a patient and feeling the appreciation of doing so as part of her reward for her hard work, no longer enjoys that reward, because she’s not allowed that task anymore.  A doctor who has admitted one of her patients to the hospital doesn’t see that patient anymore, because that hospital uses a system of hospitalists and intensivists and proceduralists and other “ists“.  Yes, those folks are highly specialized, but there doesn’t seem to be a continuum of human care — not for the patients OR their providers.

One thing we patients can begin to do, is to know that we’re all in this together.  Maybe that’s our one commonality — nobody is happy with the system.  But that one commonality, and understanding that other person’s point of view, can help us develop ways to move forward and ultimately to improve our care.

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

Often their own patient-hood causes some sort of epiphany.  That “aha!” moment that helps them GET IT.  Their work is no longer their job, or their career.  It becomes a total understanding of how their patients feel, how they are fearful, confused, frustrated and anxious. It creates empathy.

This came to mind today because I found two articles that address the subject.  The first was published in Healthy, edited by Amber Smith of the Syracuse Post Standard (the newspaper that carries my biweekly column) — called Doctors As Patients, it tells the stories of five doctors who had their own experiences as patients and all of whom feel much better prepared to do their work now.

The second was an article about Dr. Ron Davis, president of the AMA (American Medical Association) and his diagnosis of pancreatic cancer.  I’ve blogged about his article on my About.com site.

Regardless of their experiences, most doctors will still never “purely” understand the feelings of inadequacy each patient feels when it comes to understanding his or her medical problem.  No doctor can ever subtract his or her knowledge.  Further, when a doctor goes into treatment, there is still a professional courtesy that goes along with it.  Regardless of what form all that takes, the experience is still different.

But if I had my choice?  I’d most certainly choose a doctor who’s been in that very vulnerable position of having been a patient himself or herself.  That doctor will most definitely be more empathetic. It’s a perspective that will serve him or her well in practice, for sure.

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

It’s backwards from those we hear about more frequently.  Most of the time we hear about a “missed diagnosis” — meaning someone has a disease or condition and it is not diagnosed — and then does not get treated.  In the case of a cancer, of course, no treatment may mean the difference between life and death.

This summer we were able to prove that two other people, Heather and Daniel, had been diagnosed with cancers they did not have, almost identical to my own misdiagnosis.  In our cases, we were told we had something we didn’t.  Missed — yes — but backwards from the more usual case described above.

And it seems another person has suffered this fate as well — as written about in today’s Post-Tribune (from northwest Indiana — not far from Chicago) — a gentleman named Albert Velasquez Jr. was diagnosed in 2003 with lung cancer.  He did exactly what he was supposed to do — went for a second opinion — and the second lab also told him he had lung cancer….

Except that he didn’t have it.

As near as I can tell, he never received treatment for it either.  About three months passed between his first tests and the ultimate discovery of his misdiagnosis…. and if you substitute his name and type of cancer for mine, we could be telling the same story, except for two distinct points:

1.  That his misdiagnosis was a result of switching lab specimens. This happens WAY too frequently.  Lab techs are in a big hurry and swap one person’s samples and name with another.  I suppose they catch themselves when something like this happens (or if a woman is told she has prostate cancer?) — but studies tell us it happens daily.  About 1% of them lead to dangerous treatment mistakes, according to a pathologist at the University of Pittsburgh. But he also pointed out that “you wouldn’t want to have 1% of airplanes crashing.”

2.  Albert Velasquez has filed a lawsuit. I did not.

His suit is asking for damages to cover the extra costs needed from the misdiagnosis, and proof that the right person was eventually informed of his misdiagnosis.

So what can we patients do with this information?

I hope it will show you that when mistakes are made, it becomes incumbent upon us — the patients who pay for the mistakes — to figure out the real truth.  We need to trust our intuition, pull out all the stops, and keep following the evidence to prove — or disprove — our diagnosis.

Here are some tools:

1. Learn about the concept of differential diagnosis — and keep asking questions.
2. Make sure you get at least one second opinion (even a third, if necessary, just like Mr. Velasquez did).

If you have been diagnosed with cancer, then yes, there is a better chance you do have it than don’t.  But why on earth would you risk those horribly invasive treatments like chemotherapy or radiation if, for want of another test or opinion, you don’t have it?

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com

Wrong site surgery — a “never event” that takes place an estimated 100 - 200 times per year in the United States. In this case, the patient was supposed to have his fractured right hip replaced with a new one. However — the patient woke up in the recovery room with — surprise! — a new LEFT hip. Yes, the surgeon had replaced the wrong hip. And of course, the right hip was still in the same fractured state it began with.

I can only imagine that this mistake took place like most of the wrong-site surgical mistakes do. In a hurry (because, never forget - time equals cost), shortcuts were taken. And who pays the price? The patient, of course. Oh yes, the hospital will now pay a $ 6,000 fine, too — more about that in a moment.

According to the article and the New York State Health Department, this is what took place:

• Instead of marking the skin on the correct hip with a skin marker, the surgeon used a ball-point pen.
• + The surgical nurse didn’t know whether or not the skin had been marked, so he or she prepped the wrong hip.
• + The nurse who transported the patient to the operating room never verified the correct side either.
• + The “time out” process, which is required by the Joint Commission (the group that accredits hospitals) was not followed. (Of course not — time OUT is expensive!) There are actually three required Time Outs: 1 - before anesthesia, 2 - before any cuts are made, and 3 - post surgery, they are expected to account for all the tools and materials used that should not be left behind in the patient.
• + The MRI films were not displayed in the OR for review prior to the surgery.

= one patient who is far worse off than when he or she was admitted to the hospital for surgery.

There’s no mention of what happens to the medical personnel who made the errors. One can only hope they are being dealt with. (And I won’t even go into the hospital policies that caused them to take short cuts to begin with. Were they running behind? Were they pressured to make up time? No excuses — but I do recognize that the pressures on these folks are outrageous, and then, as usual, we patients pay the price….) But I digress…

The hospital was fined $6000. I wondered — who gets that fine money? Where does it go? Hospitals all over New York State (and every other state, too) get fined on a regular basis. Does the money simply enhance the general budget? (Are we going to try to make up for Wall Street’s woes by fining healthcare facilities?)

So I called the New York State Health Department. After several minutes of being passed around from one department to another — I actually found someone who was very helpful! Peter Farr, from the Bureau of Hospitals, explained that until recently all that money simply got deposited into the general fund. BUT! Recent new legislation has established the Patient Safety Center, and now most of the fine money will be funding that program. The Patient Safety Center will be tasked with transparency issues — reporting all that data that we patients have not had access to, but will begin seeing (and hopefully using) in the near future.

You know, though, we patients can all learn from this wrong site surgery story:

• If you will have surgery, mark the area of your body that is to be operated on. Use a marker that won’t wash or rub off right away (like a sharpie), and mark “THIS HIP” or “CUT HERE!” or whatever works for the surgery you’re about to have.
• Then mark the area that could be mistakenly opened. “WRONG HIP” or “NO! NOT HERE!” on parts that could be cut accidentally.
• Before they give you that pre-sleep drug, and anytime you see or encounter anyone who might be in the OR, remind them to take their “Time Outs.” Don’t worry about whether someone will be in the OR or not — assume they all will, and remind them all. Ask your loved one or advocate who is with you before your surgery to do the same.

I have to think that the surgical personnel at this hospital are just as appalled as anyone else about this mistake. They will be second-guessing themselves for a very long time, and I’m sure they will be correcting themselves and being far more careful in the future.

So my advice is simply for the rest of us to learn from their errors — and perhaps to think some good thoughts for that poor patient who had two hips replaced in one day, and will hopefully recover 100 percent.

(PS — If you are the patient, why not get in touch? We’ll keep your identity anonymous, but we’d love to hear your impressions…. email blog (at) epadvocate.com. )

	Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips
	- - - - - - - - - - -
	Join Trisha in the Patient Empowerment Forum at About.com
	- - - - - - - - - - -
	Or link here to empower yourself at EveryPatientsAdvocate.com