About Those Hospital-Acquqired Infections…

by Joanna Smith on Jun 30, 2010

There has much talk of late about the risk of acquiring an infection while you are a patient in the hospital, so-called “nosocomial” infections or “hospital-acquired infections”.  These are differentiated from those acquired outside the hospital:  these are known as “community-acquired infections”.

Over the more recent years, major attempts at educating healthcare providers in the hospital on how to reduce the risk of contributing to a “hospital-acquired” infection have been made.  One of the simple preventive actions a healthcare provider can take is to wash his/her hands upon entering a patient’s room, and this is where the focus of the education has been.  Interestingly enough, according to recent news releases, these efforts have not significantly reduced the infection rates in hospitals.

Currently a new attempt is being made to encourage patients to be active participants in a “have you washed your hands?” program:   they would be the ones to ask their care providers in the hospital if they had washed their hands before coming in the room. It’s being cast as a way for patients to be active participants in their healthcare.

This strikes me as a curious shift in responsibility.  To ask a patient or family to be the one to ask a team of doctors or the nurse or the lab technician “did you wash your hands–and for how long–before you came in?”   ignores the fact that most patients and families are quite intimidated by hospitals, doctors, nurses and other hospital personnel. Ultimately, we have to be realistic about who is responsible for hand-washing:    it’s the medical professionals and the hospital staff.    This is simply not a situation where the concept of “equal partners in healthcare” is appropriate.

I”m Not a Patient: I’m a Consumer!

by Joanna Smith on Jun 22, 2010

I almost entitled this “Please Don’t Call Me a Patient” until I realized this is not something we ask politely for anymore:  this is the new world of the empowered consumer as a self’-made advocate!

In the “old world” of medicine, people seeking care were patients.  The origin of “patients” is from the Latin for  “to suffer or endure”.  Is that a relevant description for today?  Only partially.  Yes, people who are ill do suffer and endure, but they are also taking steps to learn about their options, talk with others in a similar situation and research centers of excellence and specialists.  They approach their providers with this information, and are collegial in their approach to their care:  they don’t ask a healthcare provider to tell them what to do:  they discuss options, risks and benefits and outcome data and then decide with their provider what options to take.  This is a very different way to approach healthcare.

So language needs to follow the shift:  rather than a “patient”, which conveys a static, “waiting-for-someone-to-tell-me-what-to-do” position, I think the title now is “consumer”. People look at healthcare as a product they can research and purchase.  These consumers have shifted away from the old model to the empowered healthcare model.  Patients no more, they are driving some of the most significant changes in healthcare delivery today.

Medical Lingo

by Joanna Smith on Jun 16, 2010

I teach workshops around the country for people interested in the field of healthcare advocacy, either in becoming an advocate for others or learning how to advocate for oneself.  Because there are a mix of medical professionals and consumers in these workshops, I need to be sure that I refrain from using “medical lingo” so everyone can understand the course content easily.  It has been harder than I thought to do this!

What is it about the world of healthcare, where someone leaving the hospital is “a discharge” and we talk about surgeries as a Whipple Procedures or a CABG (pronounced “Cabbage”)–and we use that language with the patients and clients we work with.  How easily that language slips out!  What I am realizing is that the world of healthcare is a foreign language–just as the worlds of insurance or accounting or law are separate languages.  And people entering the universe of healthcare, under stress, without knowing the language or having an interpreter to guide them–end up under even more stress.  We end up sounding like an exclusive club–and that’s not good healthcare delivery.

So what can we do?  Drop the medical language when talking with patients and clients.  Draw pictures instead; talk about risks and benefits to whatever is being considered; don’t be rushed in explanations; involve the individual and their family in a discussion that is exactly at their level of understanding.  It’s up to healthcare professionals  to figure out and match that level.  So the focus is on us speaking our client’s/patient’s language, not the other way around.

23 and Me–and You

by Joanna Smith on Jun 11, 2010

In today’s newspaper was an item about “spit parties” where participants gather together to give saliva samples that can undergo genetic analysis.  There is a company in California that does this kind of testing–the company name is “23 and me”–and it’s moniker is “genetics just got personal”.  The company name, according to their web site, ” refers to the 23 pairs of chromosomes that make up each individual’s genome.  23andMe connects individuals to their unique, paired set of 23 chromosomes”.

What is particularly interesting is that  people are curious, and are willing to sped upwards of $399 to find out this information.

This is the world of new medicine: the information can be out there, for a price,and people are curious and would like the information.  So, if you were to appear at your doctor’s office with a genotype of your DNA, he or she might ask:  what can I do with this?  How will it currently help me keep you in good health? And that is the dilemma of healthcare today:  we can access very sophisticated information, but knowing how to apply it and where to go with it remain a challenge.

It’s one of the reasons healthcare advocates are so critical today:  helping the consumer know what to do with the information they acquire!

Electronic Medical Records: Who Benefits?

by Joanna Smith on Jun 10, 2010

“In a survey conducted by Harris Interactive for the Xerox Corporation, Healthcare IT News reports about half of Americans support the switch to electronic health records, but felt that patients themselves  have  the least to gain from EHR adoption.”

This is very curious!  While EMRs will make billing easier for providers, one of the big changes for the patient/consumers is that that they will have increased access to those records.  If they are on vacation in Idaho and are in an accident, their providers in Alabama could transmit the entire medical record to Idaho.  That would greatly assist the Idaho providers in providing the best care possible.  Or, if you live in Texas and decide to seek a second opinion at a center of excellence in Minnesota, your complete file could be available to all the specialists on that team.  So access will increase, and coordination of information should be improved.

What many people are concerned about is the security of their on-line medical information, and they do not yet see the benefit of improved access.  What they believe is that providers are going to EHR because they’re getting extra money to convert to that system (that is partially true); the consumer/patient is not being asked “do you want to do this?”  They are being told as it is happening “we’re doing this”.  That’s an unfortunate approach:  what works best to change the public’s opinion is education over a long period of time about the change and the advantages.  In many ways, the transition to EMR left out a critical component:  the patient!

A Sea Change

by Joanna Smith on Jun 9, 2010

Reported today in the California Healthcare Foundation’s iHealth Beat: “Three hospitals, 100 primary care physicians and 25,000 patients will participate in a yearlong pilot project funded by the Robert Wood Johnson Foundation Pioneer Portfolio to evaluate the impact of giving patients online access to doctors’ encounter notes.” As found in:HealthLeaders Media.
What a change! From the years where the patient had no access to medical records (because they were considered the property of the providers, both in the hospital and in a clinic) to today: where patients have access to Doctor’s encounter notes! An astonishing change in the view of what constitutes appropriate access to one’s own medical information. It’s an exciting study and it will be interesting to see if having access leads to better health and better healthcare!