Tips to Prepare for Emergency Room Visits

Recently our client, Mary, went to the local ER with abdominal pain, nausea and vomiting.   After 7 hours, Mary left the ER without knowing her diagnosis or understanding how to take the new medications prescribed or even when to follow up with the doctor. This is not an unusual scenario. In our fast-paced health care system, many patients don’t understand their illnesses, their medications and treatments. And all too often, doctors don’t have the time to explain. One of the riskiest points of care for anyone, particularly for elders, is emergency care. Elders are especially vulnerable because they often go to the ER alone, have multiple medical problems and many treating physicians. Typically, elders are not good “historians”, and do not provide detailed explanations of their medical problems, current symptoms and medications.  And elders are often hesitant to speak up and ask questions.  According to a recent article in Health Affairs, when you are a patient who is actively and knowledgeably involved in your health care- an “engaged patient”- you are healthier, get better care and have lower health care costs. So it is very important that you understand your health care needs, conditions and medications and know how to communicate with doctors, especially in emergency situations. Certainly, you want to do all that you can to avoid an emergency room visit. So whenever possible, call your doctor for medical advice as soon as you have symptoms.  In urgent situations, when an emergency room visit is indicated, ask your doctor to call ahead to the ER to provide information and help expedite decisions about your care. In preparation for emergency situations, carefully develop a detailed support plan with your family/friends.  As part of that plan, prepare emergency information documents to include: Doctors’ names, specialties and phone numbers. Emergency contact numbers for health-care proxy and next of kin. Personal Health Record (PHR), advance directives, health care power of attorney documents and POLST (Physicians Orders for Life Sustaining Treatment). List of prescription, over-the-counter medications and herbal supplements or vitamins, including dosages and frequency. Allergies, to medications, foods, contrast dye or latex. Here are some tips to help prepare for emergency room visits: Never go alone to the ER.  Have a schedule planned with family members or friends to go along with you should the need arise.  And, your companion should stay with you at the bedside at all times during your emergency visit. At the ER, if you are able, provide a thorough history and detailed explanation of your current symptoms.  Do not edit your history or minimize or exaggerate your symptoms; this can cause the doctor to misdiagnosis your problem. Ask questions.  Speak up if you do not understand the...

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Some Tips for Choosing Your Doctor

One of my clients told me how she found her new primary care physician through the online rating sites of Vitals and Healthgrades.  This is very risky process for choosing a new physician. Recently, there has been a great deal of coverage about how dangerous reliance on these sites can be.  See this Blog warning about the dangers of using online doctor ratings. Finding a doctor is one of the most important searches you will ever undertake.  You are entrusting your health and your medical care to a physician that you are about to hire.  The research that you do to find a new doctor ought to be carefully planned and researched.  It’s not a good idea to go to Dr. Jones just because she has 4.5 stars on Healthgrades or because your neighbor likes her. You need more objective information to find a doctor who is reputable, competent and well matched to your needs and care goals. Gathering basic information is a good starting point. For example, where did the physician go to medical school?  Where did he/she complete residency? At which hospitals does the doctor have admitting privileges? What papers has the doctor published?  Check your state’s medical board website for licensing and malpractice information. Also, U.S. New’s Top Doctors can identify doctors recommended by their peers based on their clinical skills, including how well they relate to patients, and other qualifications such as education, training and hospital appointments. Once you have narrowed the list to a few physicians, call each medical office and evaluate its efficiency. What is the demeanor and cordiality of the office staff?  How long does it take to get an appointment with the doctor?  What is the average wait time to see the doctor?  Are lab work and x-rays done in the office? Are weekend hours available? Does the doctor work in a physician-owned practice or a practice owned by a hospital? Does the doctor have nurses on staff?  Inquire about emergency coverage on weekends, holidays and nights. If you are satisfied with the answers you receive, then place an introductory call to the doctor.  Many physicians welcome this sort of call to help decide if the doctor is a good fit for your needs.  Ask questions about the physician’s style of practice. Does the doctor consider patients as partners in their care?  How much time is spent educating patients about their illness and treatment plan? What if you have questions or don’t agree with a treatment recommendation; how is that handled? Does the doctor have email correspondence with patients? Pay attention to the willingness of the doctor to provide information. Did the doctor listen carefully to your questions? Were your questions answered...

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Bob’s Story (As Told by His Wife of 35 Years)

“After my husband was released from the hospital he started to breathe very loudly.  We went to the hospital to see why.  They explained that during the time that he was intubated in surgery it left scars on his trachea. They wanted to operate and remove the scaring.  The operation was to only take about 30 minutes and that he would be fine.   After waiting about 2 hours the doctors finally came out and explained to that it didn’t work and they had to perform a tracheal {tracheotomy} to help with his breathing.  They told us it would only be there for a short time.  After several times of trying to close it they said they couldn’t do anything else to help him.  That’s when I started getting extremely frustrated.  I felt helpless and there was NO ONE who cared.” This is a heart-breaking story that unfortunately occurs all too often. Thinking that doctors put the patients’ needs first- is a major mistake made by patients according to Trisha Torrey’s book, “The 10 Mistakes Every Patient Makes.” Medical practices have changed dramatically over the past two decades.  As a result, many physicians are overburdened, overbooked and saddled with administrative and insurance company regulations and demands. Doctors are struggling to maintain their own survival in a challenging and changing health care system.  Thus, you, the patient, must be your own best advocate.  You need to take charge and insure that your problems are heard, your values are respected and your health care needs are met. In today’s health care environment, it is necessary that patients are active and informed partners with their doctors in making health care decisions. Here are some ways to do that: 1)   First find a doctor that will listen to you. A doctor, who respects you, spends time with you and answers your questions clearly. 2)   Question every recommendation that the doctor gives.  You must understand the reasons for the medical recommendations and how they will be of benefit to you. 3)   Don’t hesitate to ask that the medical explanation be in understandable layman’s terms. Inquire about alternative options. Ask what are the risks and benefits of each treatment recommendation. Bring along a tape recorder and ask your doctor’s permission to use it to record the treatment review. 4)   Trust your instincts.  If you feel that the doctor’s recommendations are not right for you, pay attention to that feeling.  Get a second opinion; a third or fourth if you’re still not satisfied. 5)   Educate yourself about your illness and treatment options. An informed patient is an empowered patient.  Speak to trusted nurses, doctors.  If needed, find an independent health advocate or geriatric care manager for...

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Holiday Blues

Commercials depicting happy families blissfully enjoying the holidays can set up unreasonably high expectations for family togetherness, harmony and happiness during the holiday season.  When our families don’t quite measure up, we may feel sad and disappointed. At this time of year, all of us are vulnerable to the “holiday blues.” However, seniors and family members who are ill are at highest risk as they cope with physical vulnerabilities and associated losses such as, loss of health, mobility and loss of independence. Of note, there is a difference between “holiday blues” and depression. If the sadness does not lessen after the holidays or if sadness intensifies and disrupts daily activities, a professional evaluation is warranted. Here are some tips to consider to help deal with “holiday blues.” 1)    Keep in mind that there is no one “right way” to celebrate the holidays. Don’t be a slave to past traditions. If you don’t feel up to it, change your traditional celebration and start a new family tradition. 2)    Don’t take on too much.  Delegate some holiday tasks to others. It is important to balance social demands with sufficient rest and relaxation. 3)    Lower your expectations.  Don’t expect family members to change for the holidays or expect to have the perfect family celebration. Embrace the quirks; they are what make your family unique! 4)    Encourage reminiscing during holiday celebrations. Listen to family stories. Story telling, even when not completely factual, can go a long way to making each family member feel appreciated and valued. 5)    Involve seniors in holiday activities. Ask for traditional recipes, encourage them to help with meal preparations, decorations, sending cards, baking pies, cookies and so forth as their ability and interest allow. Remember the best holiday gift is spending time with, and being present for, your loved...

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Interview with Dr. Nancy

A recent interview about health advocacy on Radnor Channel 21 “Healthy World, Healthy Nation, Healthy You” with Dr. Nancy featuring Dr. Arlene Houldin and Dr. Connie Carino.

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Medical Treatment Decision-Making: Sometimes Less is More

You may have heard about the practice of “slow medicine” which refers to careful, attentive medical care; mostly focused on palliative, comfort care.  However, slow medicine is much more than that. This practice suggests using a holistic approach to health care, with thoughtful consideration of recommended medical interventions, weighing both benefits and burdens during acute and chronic illnesses. Today’s New York Times blog post illustrates the importance of making careful, “slow” decisions- fully informed by individuals’ and families’ care goals and values- early on in the health care...

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