Patient Advocacy: Knee and Hip Replacement Surgery

Over the past couple years, fewer patients are receiving post-surgical rehab after hip and knee replacement surgery as reported in the 12/14/15  Philadelphia Inquirer article, with many patients skipping physical therapy entirely. This is a concerning trend, since practice is changing without rigorous study to provide information on the effect of the decrease in rehab support on patient outcomes. After joint replacement surgery, decisions about rehab ought to be individualized to take into account the presence of other illnesses, patient’s cognitive functioning, and the ability of family members to assist with post-surgical care. As a patient advocate, I counsel my own clients to have thoughtful conversations with their surgeons before surgery to discuss the surgeons’ rehab practices, and the patients’ medical history, home situation, and availability of family support to be certain that rehab decisions are carefully aligned with patients’ needs....

Read More

Knowledge Is Power

It’s important that you know what is documented in your medical records, since well-informed patients are more likely to take better care of themselves, adhere to prescribed treatments, and be more proactive about their health care. For many reasons, what you hear from your doctors during office visits or hospital stays, and what is actually recorded about you in the medical records may be quite different.  Medical records can influence your care, reimbursement, and eligibility for benefits.  So, it is useful to know what is actually documented about you. See relevant article in NY Times. Undoubtedly, you will encounter some resistance to sharing your medical information. “The person with the least access to data in the system is the patient,” as noted in this NY Times article.  “You can get your records, but the burden is always on the patient.” Despite the obstacles, it is important that you advocate assertively to obtain your medical information. Knowledge is indeed power.  While individuals may vary as to how much detailed medical information they wish to know, the fact is that copies of your medical records are important to review to help insure coordinated, informed, quality care. It is your right to know what is written about your diagnosis, health condition, prognosis, and recommended treatments. Some tips to obtain your medical records: Ask your doctor directly for the records during your medical visit. Request the CD after getting scans or x-rays.  Ask for copies of your records at the time of service, don’t wait until later when you have to go through various administrative levels to obtain your medical records. Organizing the medical information you gather using your own  Personal health records (PHR) is a good way to keep track of, and communicate, your health care needs and medical history. It is essential that you do all you can to insure that you are receiving the highest quality care possible.  ...

Read More

When Considering Assisted Living Facilities: Two Essential Items

At the point when family’s worries grow about the home safety of an elderly loved one, the search often starts for suitable assisted living facilities. There are many useful guides with  criteria and checklists available to assist with this search. Most often the search criteria focus on location, cost and reputation of the assisted living facilities. However, before deciding on an assisted living facility, consider two often overlooked elements that may directly impact the quality of elder care: advance directives and licensed nursing coverage. First, advance directives are important since medical decisions will most likely need to be made about the treatment of acute and chronic conditions while at the assisted living facility. It’s important to thoughtfully prepare to make these medical care decisions. Understanding that there are treatment choices, which ought to be consistent with the elder’s values and preferences. For example, should dad with a diagnosis of advanced dementia have a feeding tube inserted for swallowing problems? Information to guide the aggressiveness of the medical care is necessary. The benefits and burdens of various procedures/treatments should be carefully weighed in order to honor the elder’s preferences for care as much as possible. Then the elder, family, and physician can directly address the question; when do the medical tests and interventions prolong suffering and do little to improve quality of life, and when are these interventions necessary to enhance quality of life and relieve symptoms? Thus, the first priority for elders should be the careful completion of advance directives, POLST, and health care power of attorney documents. Next, the documents need to be shared widely with all family members, doctors, health care providers, and anyone else involved in making health care decisions. While these documents have their limitations, what is most helpful is the process of thoughtful conversations with family and care providers about the elder’s needs and treatment preferences (see  conversation guides). As a result of these conversations, the elderly loved one’s values and preferences for type and aggressiveness of care are better understood and specified. And most importantly, a health care power of attorney can be carefully chosen who will understand and honor the elder’s wishes. Secondly, when the time comes to look for assisted living facilities, be sure to inquire about the availability of licensed nursing coverage. According to a recent NY Times article, a major obstacle to offering more treatment procedures in nursing homes is the fact that many Medicare-certified nursing homes do not have nurses on staff 24 hours a day. Since in most states, federal regulations require nursing coverage only eight hours a day. So for example, if a licensed nurse were not on the staff of the assisted living facility, the elder would...

Read More

Hospital Advocacy: Surgical Pain Management

Over the past 2 weeks, I have witnessed extraordinarily poor pain management for patients after major surgeries.   Post-operative pain management is an important, but often undervalued, part of quality surgical care.  How many of us ask about the surgeons’ pain management plan when we’re considering a surgical procedure? We have known for many years that surgical pain is often underestimated and undertreated.  Despite the fact that more attention has been paid to pain management in recent years, many patients continue to suffer with poorly managed surgical pain. Recent reports estimate that 70% to 80% of surgical patients experience moderate, severe or extreme post-operative pain. There are serious consequences when pain is poorly managed. In addition to the needless suffering of patients, the chances of respiratory and clotting complications are increased, as well as a longer hospital stay and development of chronic pain syndrome. It’s important to know that it is your right to receive proper pain management after surgery. Hospitals have pain management standards to which they are held accountable. The standards require hospitals to: recognize the right of patients to appropriate assessment and management of pain screen patients for pain during their initial assessment and, when clinically required, during ongoing, periodic re-assessments educate patients suffering from pain and their families about pain management   What can patients do to improve their pain management after surgery? Before your surgery, have a discussion with your surgeon about pain control. Ask your doctor what to expect after the surgery and what is the surgical pain management plan. Ask about the different options and methods of post-operative pain management and their benefits and side effects. Tell your doctor about all pain medications that you are taking before surgery. Share with your doctor any problems that you may have had with pain control after prior surgeries. Ask how pain relief is monitored. By whom? How frequently? What is the plan if there is inadequate pain relief? Often problems with pain control occur when patients are transitioned from IV PCA (patient controlled analgesia) to oral pain medications after surgery. Ask about your doctor’s transition plan. Is it tailored to your pain needs or does your doctor follow a specific protocol? Good coverage needs to be carefully planned during this transition.  All too often however, surgeons employ a “one size fits all” approach using the lowest dose of oral pain medications to start, which is arbitrarily used for all patients regardless of type of surgery, weight of the patient and previous pain medication use. An individualized, evidence-based, post-operative pain management plan should be your surgeon’s routine practice. If you are not satisfied with your doctor’s responses to these questions, by all means get another opinion. ...

Read More

Communicating with Your Doctor

Clearly communicating  your needs, or the needs of someone you care for, to the physician is often a challenging task.  See the link to my recent blog on “assertive communication for safe patient care” that was posted on The Caregiving Space....

Read More

A Heartfelt Gift for Mother’s Day

This is National Heart Week 2014. Since heart disease is the # 1 killer of women in the US, here is a gift that you can give to all the women in your life this Mother’s Day.  The gift of “heart care awareness”.  Consider using the information to start a conversation on Mother’s Day about the importance of heart health. *Heart disease symptoms are different for women than for men.  According to the Mayo Clinic, the most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. But it’s often subtle discomfort, such as pressure or tightness in the chest, not the sharp crushing chest pain usually linked to heart attacks. *Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as: Neck, jaw, shoulder, upper back or abdominal discomfort Shortness of breath Right arm pain Nausea or vomiting Sweating Lightheadedness or dizziness Unusual fatigue *Often women tend to show up in emergency rooms after heart damage has already occurred because they minimize their symptoms and their symptoms are not those typically associated with a heart attack. Women should understand if they experience any of these symptoms, call 911 immediately. *There are several lifestyle changes women can make to reduce the risk of heart disease: Quit or don’t start smoking. Exercise 30 to 60 minutes a day on most days of the week. Maintain a healthy weight. Eat a healthy diet that’s low in saturated fat, cholesterol and salt. Prioritize stress reduction in daily life (women may be more vulnerable to stress-induced heart problems than men). And be sure to take prescribed medications appropriately, such as blood pressure medications, blood thinners and aspirin. It is essential that the medical conditions, which are risk factors for heart disease, such as high blood pressure, high cholesterol and diabetes, be managed well. *If women have heart disease or have undergone procedures like heart valve replacement, stenting or transplants, they may be eligible to enter a cardiac rehabilitation program paid for by Medicare.  Access to these programs has recently been expanded (see the related NY Times article.)  Cardiac rehab programs can help improve overall health and quality of life. So women, ask your doctor if you are eligible for referral. Happy & Healthy Mother’s Day!  ...

Read More