CHW Healthcare Blog

Quote for the Day

"What we need is what the ancient Israelites called hochma - the science of the heart - the capacity to see, to feel, and then to act as if the future depended on you. Believe me, it does." — Bill Moyers

To Care Even When We Cannot Cure

There's a flurry of articles today (see here and here for a couple of examples) about the benefits of palliative care. We've had palliative care teams at our hospitals for many years because we believe it is a method of treatment that respects the dignity of individuals suffering from chronic or life-threatening illnesses.

At its core, palliative care is about respecting the wishes of patients and families. Previously, the standard course of care for patients suffering from a terminal illness called for aggressive treatment up front, and then, when the resources of modern medicine had been exhausted, palliative care (also called comfort care) would begin.

Today, our caregivers work collaboratively with patients and families to give people suffering from serious illnesses a voice in their care and clear, ongoing communication with their physicians and other health care providers about what to expect.

Providers at our hospitals are guided by the following principles:

• Respect the wishes of the patient: There is no obligation for any patient to begin or continue life-sustaining treatment, if from the patient's perspective it is an excessive burden. An individual's decision to refrain from treatment will be respected even when such a decision may result in the person's death.
• Effective pain management: Health care must be a community of respect, love, and support for patients and their families as they face the reality of death. Pain management will be of the highest quality and is critical in allowing a person to die comfortably and with dignity.

The charge of medicine is to care even when it cannot cure. At CHW hospitals, physicians, nurses, pharmacists, chaplains, nutritionists, and many others work together to determine the appropriate use of drug and non-drug interventions for the relief of pain and symptom management.  Providing quality care to dying and seriously ill patients is an important issue for us and we are advocating for public policies and programs that will improve palliative care.

Being the Change

News out of New York over the weekend that a physician is taking it upon himself to help those living without health insurance. Dr. David Ores has started a health care cooperative for restaurant workers:

Here's how it works. The restaurants pay $1 for every seat in their restaurant. That money goes into a special fund, which then goes to pay for the health care. "Health care should be like water or food or housing," Dr. Dave said. "A basic human right, not a luxury.

...

With the potential to reach thousands desperately needing health care, Dr. Dave is lowering the barrier to that care. "To fix things earlier, to intervene early is 100 times less expensive than you wait for it to become a complicated case of pneumonia," Dr. Dave said.

We applaud Dr. Dave for his innovation and compassion for those in need. And we call upon our nation's leaders to learn from Dr. Dave's example - access to quality care is a basic human right. It should be available to all. We'll continue to advocate for compassionate reform while also opening more clinics and extending care to all in need.

Micro-Practice

A new kind of clinician is emerging in America. One whose practice is smaller, higher-tech, and more under the control of the physician than health plans. The Washington Post explains:

The waiting room of Ramona Seidel's family medicine practice is empty, and she works hard to keep it that way.

After several years in a traditional suburban group practice that blended pediatrics and family medicine, Seidel quit to start her own micro-practice in Annapolis: a low-overhead, high-tech office that gives her more control over how she treats patients and more time to spend with them. She's happier. Her patients are happier. And she's pretty convinced they are healthier having a physician who knows them well.

The micro-practice model is being advocated for by the Institute for Health Improvement, which states that a successful micro-practice will "(1) have as its primary purpose a focus on the patient—a commitment to meet all patient needs; (2) make fundamental to its work the study, measurement, and improvement of care—a commitment to process improvement; and (3) routinely measure its patterns of performance, 'feed back' the data, and make changes based on the data."

There are clear upsides for the patient and the physician with this model. But with a shrinking supply of primary care physicians it may not take off as quickly as some would like. Still, it's a move in the more compassionate direction.

Compassion in Medicine

It's been out for about four years now, but the book bears mentioning. Medicine and Compassion is good for anyone - caregiver or not - but there's a lot in it that can bring into our awareness the truth of our lives.

One of the most powerful sentiments in the book is the reminder that we are all "waiting in line to die." How does that truth change the way we interact with patients, with each other?

Medical Road Rage

We've all seen it in the movies and on television: The brilliant, highly-experienced and tenacious chief surgeon berates the residents, interns, nurses - just about anyone - in the hospital for every offense, imagined or real. The surgeon gets away with this behavior because, well, s/he is brilliant, highly-experienced, and tenacious. More important, s/he brings in patients.

They are stereotyped as the playground bullies of the medical field, which is what makes this drama such rich fodder for the entertainment industry. Maggie Mahar posts an informative exploration today of the cultural divide in medicine between the doctors who "perform procedures" and those who "practice cognitive medicine."

Is there a difference between surgeons and other doctors in terms of their ability to act compassionately? It's a question that may never get answered, but something is starting to happen in the medical field to curb this kind of behavior. Namely, disciplining doctors. Take this case, reported on in The Boston Globe:

During an operation at a Salem hospital last summer, an orthopedic surgeon, frustrated by a pair of scissors that wouldn't cut, threw them and narrowly missed a nurse.

In many hospitals, outbursts from a top surgeon who generates significant revenue or a star researcher who wins huge grants often have been tolerated. But in this instance, North Shore Medical Center disciplined the doctor who threw scissors and required mandatory team training for all operating room staff under a recent policy requiring physicians to treat their colleagues with "civility and respect."

The article goes on to point out that The Joint Commission is for the first time is requiring all hospitals, nursing homes, and other health care facilities to adopt "zero-tolerance" policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders.

Good Patient Blogs

Our recent post about cancer patient blogs was such a big hit that we decided to find and publicize a few more. There are lots out there, and most of these blogs also list other bloggers they like to read. We've only listed those that look like they're being updated on a regular basis. If you're looking for a patient blog for a condition not listed here, do a Google search on the condition(s) you're grappling with + blog.

• Diabetes Mine - A blog devoted to "straight talk and encouragement for people living with diabetes." The comments are often just as helpful as the posts.
• My Cancer - Leroy Sievers' daily account of his fight with cancer.
• CancerSpot - One woman's journey through life with breast cancer.
• Crohn's Blog - A 33 year old athlete, father, and professional tells all in this "Living with Crohn's Disease" blog.
• Time Goes By - No, we don't consider getting older to be a "condition," but this is a witty, informative, and fearless blog about aging that deserves some recognition.

As we learn of other patient blogs we'll post them here for you. If you know of any good patient blogs let us know. Happy blogging.

At Odds With Your Doctor?

A recent New York Times article reports on a growing trend in American medicine -- that patients no longer trust their doctors:

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease. The Internet is bristling with frustrated comments from patients.

But doctors say the situation is not hopeless. Patients who don’t trust their doctor should look for a new one, but they may be able to improve existing relationships by being more open and communicative.

Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, “Doctor, I still have some questions.” Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.

Blogs Helping Patients

An article in the Seattle Post reports on the use of blogs to help people cope with and learn about disease. Blogging has become more than a venue for promoting opinions or summarizing news - it's a way to network with others and gain support during life's triumphs and tragedies.

The three blogs featured in the Seattle Post's story are:

Deanna Kingston: Dee's Updates
Deanna Kingston, 44, an anthropology professor at Oregon State University, was diagnosed with breast cancer in 2002. Last fall, the cancer spread to her skin and bones. While Kingston's blog is more an update for friends and family, others around the country also read it for its humor and real life daily journals. She posts "boob jokes" from her friends and family.

Jeanne Sather: Assertive Cancer Patient
Sather's Assertive Cancer Patient blog is her soapbox, she said. It shares her experiences as she's battled hospital billing nightmares, cancer recurrences, new treatments and often her opinion about almost anything going on in the cancer world.

Teresa Hartman: The Cheeky Librarian
Teri Hartman, 47, a university librarian was diagnosed with a rare cancer in the salivary glands in her cheek in July 2006. A month later, she began her "Cheeky Librarian" blog. She already had a professional librarian blog, but wanted an outlet for her cancer and posted links to sites that helped her cope. For example, a blog warned her she would lose her sense of taste after radiation destroyed her salivary glands. She was able to have her "last meals" as a result.

If there are other blogs out there about health and health care, the environment, or health care reform let us know. We are always looking for partners in our work to improve the quality of life.

Loans Available During Budget Crisis

California's budget crisis has led to a Medi-Cal payment freeze for thousands of community health clinics. According to the Los Angeles Times, "During last year's budget standoff, many providers reported paying astronomical interest rates for temporary credit. This year promises to be tougher. Banks are financially squeezed and reluctant to offer bridge loans."

We're pleased to report that it won't be as difficult as this report claims. In early June Catholic Healthcare West partnered with the California Primary Care Association and made $5 million in loan money available for California's community clinics to draw upon until the state budget is ironed out. We've been working with the CPCA to encourage others to make similar funds available. Since our initial contribution to the loan pool Sutter Health and HealthNet have each made $5 million available for community health clinics. We strongly urge others to join us in helping to keep these vital community services open.

CHW is California's largest private Medi-Cal provider so we have a very deep understanding of how important these clinics are to maintaining the viability of our already fragile health system. By helping keep their doors open we are helping to ensure that our most vulnerable residents continue to have access to the care they need, when they need it.