I ran into Dr. B. last week, a physician I really like and respect. She was seeing a patient in the hospital and I was visiting a friend who’d just had surgery. We stopped to chat. After exchanging pleasantries, Dr. B. made a comment about the sad state of healthcare. Because she knew about my books and articles on healthcare, inevitably we touch on it when we see each other.
Lingering in the hallway, the familiar sounds of the hospital around us, she said, “Many physicians are deeply frustrated. I know several who have jumped ship.”
“Me too,” I said. I thought about the number of physicians I’d interviewed for my latest book, The Take-Charge Patient, who were frustrated and disillusioned with the direction healthcare was taking. About half of them just needed an ear, wanted to vent about how disappointed they were in the profession they had chosen. Many questioned the logic of staying in medicine now that their relationships with patients had dwindled and how health insurance had taken over as gatekeepers and decision makers for patient care. This was before electronic medical records had been fully implemented.
Dr. B. said, “Oncologists are selling their practices to hospitals.”
“GYNs and other specialists too,” I said.
Dr. B. sighed. “Where do you think healthcare is going?”
I wasn’t sure how to respond in a sensitive way given that she is a doctor in the thick of the healthcare mess. I decided that honesty was the way to go, especially considering that as a patient, I am in the thick of it too. “Technology with a big emphasis on efficiency.”
Technology already plays a major part in healthcare and certainly for physicians. According to a new study published in Mayo Clinic Proceedings electronic health records (EHR) and the digital entry required to maintain them, is in part, driving doctor burn out. Intended to prevent medical errors and increase efficiency, digital healthcare requires much more screen time for clinicians. Digitation of healthcare takes away from interaction with patients. Interaction with patients is a large source of satisfaction for physicians.
Dr. B. nodded and said, “I think we’re headed toward a bigger divide between the ultra rich and the not-so-rich.”
I said, “You mean longer wait times for care and less accessibility unless you have the money to pay for it?”
I understood what she meant–that the rich could afford to pay cash to physicians who don’t take insurance or could see concierge physicians, both allowing for more immediate access and more face time with doctors. That often translates into increased quality of care and more emphasis on the all-important doctor-patient relationship. When doctors and patients bond and connect, outcomes improve.
Her cell phone chimed and she reached for it. Her eyes on the screen, she mouthed the words, “I have to go. Good to see you.”
We both dashed off to our respective destinations in the hospital. Our brief conversation kicked up my own disappointment with the direction healthcare seems to be taking and I made a mental note to do some research on it later in the day.
What I found wasn’t news to me but I hadn’t been aware of the current level of frustration with medicine. I read the HealthLeaders Media article, 1 in 2 Physicians Demoralized, Dissatisfied. It said, “Half of physicians are dissatisfied with the current medical practice environment and they are opting out of traditional patient care roles.” The article cited a new nationwide survey commissioned by the Physicians Foundation.
I was reminded that it isn’t just patients who suffer the maladies of our current healthcare system but physicians too. And a lot of them. Doctors who I interviewed for both of my books opened my eyes to widespread frustration and disillusionment.
Nurses are frustrated too. Their quest for safe staffing to salvage patient safety and quality of care seems like it would have been implemented years ago. If a nurse is caring for too many ill patients at once, safety and quality of care are compromised.
If half of physicians surveyed by the Physicians Foundation are deeply frustrated and burned out by healthcare, what can be done to bring back fulfillment and satisfaction to their work?
That burnout, experienced by nurses too, affects everyone involved in patient care, including patients. According to the AHRQ Patient Safety Network, “Burned out clinicians may develop a sense of cynical detachment from work and view people—especially patients—as objects. Fatigue, exhaustion, and detachment coalesce such that clinicians no longer feel effective at work because they have lost a sense of their ability to contribute meaningfully.”
Physician burnout has been associated with decreased patient safety, increased diagnostic errors and less patient engagement. See Health Affairs article, Make the Clinician Burnout Epidemic a National Priority
With the pressures and requirements driven by the Affordable Care Act (ACA), its no wonder so many clinicians are finding other ways to survive in healthcare, either by becoming concierge physicians, offering more income-producing services, selling their practices to hospitals, and more. Some are getting out completely.
Most physicians I interviewed for The Take-Charge Patient did not think highly of the ACA. Many predicted that it would crush the practice of medicine as we know it.
With declining reimbursements and more time spent on data entry to fulfill electronic health records (EHR) requirements mandated by the ACA, physicians see even more patients in a day just to survive. The Forbes article, The Story Behind Epidemic Doctor Burnout and Suicide Statistics reports, “On a typical day, Dr. X would arrive at the clinic with a full schedule consisting of 20 to 25 patients. Dr. X said, “If you do the math, that limits my time with each patient to seven to ten minutes.” He goes on to say that in those seven to ten minutes he had to address the acute problems that brought patients into his office plus those with chronic conditions. Dr. X added, “Most of those minutes were spent interacting with the computer screen.”
Dr. X also explained that “Meaningful Use” requirements forces doctors to spend more time filling out forms and dealing with coding requirements, which leads primary care physicians to refer patients more often to specialists because they just don’t have the time to address the problems themselves.
To fuel the fire, health insurance has lassoed healthcare. Some physicians opt to forgo accepting health insurance altogether or to transform their practices into concierge which comes with a price for patients. Narrowed networks on health insurance plans deny patient access to certain clinicians, hospitals and other healthcare facilities, forcing patients to find other doctors and care from other facilities.
With the dramatic increase of high deductible health care plans in both group and individual markets, results are mixed, at least for now, on whether patients are actually avoiding necessary care or whether they are becoming cost-conscious users of healthcare services.
Personally, I know of many patients who do not seek care from their doctors because high deductible plans have converted them into cash-pay patients and they simply cannot afford to pay the high deductible before their plan kicks in. See my article in KevinMD on Cash Pay Patients and High Deductible Plans. This affects physicians and other clinicians too. If a patient doesn’t see his/her doctor or nurse for, let’s say, diabetes management because of the expense, then how can that clinician take care of the patient properly? How does that patient effectively manage the chronic condition on his or her own? The rationale for high deductible plans is that patients will use fewer healthcare services and save money for everyone.
Hmn. I’m not sure I agree.
For years, health insurance has overruled what physicians knew to be best treatments and tests for their patients. For good reason in some instances to prevent over testing and fraud. But as I see it health insurance has zapped some of physicians’ sense of autonomy and effectiveness. This too contributes to physician burnout. It certainly frustrates patients.
Who is getting caught in the drain? Seems like doctors, nurses and patients.
The ACA does have benefits. Preventing health insurance plans from denying care to those with pre-existing conditions is an obvious vital change. Offering access to care to those who were previously denied it, is also an essential benefit. But at what cost? Unfortunately, the ACA has robbed Peter to pay Paul.
What can be done?
I don’t claim to know the answers. I do very much welcome your comments.
Ageism is alive and well in the U.S. Take Elaine, (name changed) a 90-year-old woman who lives alone in a major city back east. She and I developed a casual email relationship over the last few years ever since my first book was published. Recently, she shared with me that she’d reported her symptoms of cognitive decline, back pain, and other problems to her primary care physician. According to Elaine, he said, “Those are all a part of getting older.”
Elaine felt dismissed, not taken seriously, and she continues to cope with symptoms that truly worry her, not to mention her discomfort and pain. If her emails are a sign of cognitive decline, I’m not sure, but there is a change from five years ago. Now her words are half sentences, and sometimes a list of single words strung together, one of which recently was “despair.”
I’ve encouraged Elaine to reach out to her adult children who live states away. I’ve sent her resources for older seniors in her area. If she’s not up to making the calls, I don’t know, but I keep trying. I recently sent one of her adult children one of my books with a note explaining that although I don’t know Elaine very well, it does seem that she needs help.
Elaine’s story of isolation and loneliness is heartbreaking, to say the least. She’s not the only one either.
The Huffington Post article, How our broken healthcare system treats the elderly, is a sobering look at how older people are brushed off and ignored simply because of their age.
Our healthcare system is broken, but our older population can’t just be forgotten, left to fend for themselves.
Take our neighbor, Dorothy (name changed) who is in her 80’s. My husband and I look out for her and have helped her a number of times through the years. Before she had 24/7 caregivers, something most cannot afford, I took her to the hospital after a bad fall, drove her and her dog to the vet hospital after her dog had a stroke, among other things. My husband assisted with an air conditioning repairperson who tried to sell Dorothy an expensive new unit that she didn’t need. Her children do visit regularly. But unless you’re around all the time it’s not always easy to see what is really going on. And I think Dorothy hides some of the truth from her children as she feels embarrassed that she’s no longer independent. After talking with her son, he accompanied Dorothy to see her internist for a medication review of the 17 daily medications she was taking. Thankfully, this doctor was on top of things and weeded out unnecessary medicines.
Some older people aren’t so lucky and end up in nursing homes dealing with polypharmacy, overly medicated and barely able to function.
Many older adults feel marginalized and lonely, according to The New York Times article, Researchers Confront an Epidemic of Loneliness. According to the study cited in the article, loneliness and isolation are associated with increased levels of cortisol, a major stress hormone. “The profound effects of loneliness on health and independence is a critical public health problem,” stated Dr. Carla M. Perissinotto, a UCSF geriatrician.
I’ve written about loneliness in seniors before and how it can be hazardous to one’s health.
Whether Elaine’s recent exacerbation of cognitive and physical problems are a sign of increased loneliness ever since a local coffee shop and market closed, a place where she used to meet with other older people, I don’t know. But my guess is that it is.
The AARP Foundation lists risk factors for isolation.They are:
- Living alone.
- Mobility or sensory impairment.
- Major life transition such as losing a job, retirement, death of a spouse, etc.
- Low income, limited resources.
- Psychological or cognitive vulnerabilities.
- Inadequate social support.
- Loss of social network.
- Loss of transportation.
Ideas to Help
- Transportation. Lack of transportation is a primary cause of social isolation, according to A Place for Mom. Perhaps companies like Lift or Uber could create a nonprofit arm to drive older adults to social activities, medical appointments, places of worship, and more.
- Volunteer. If you care for an older person, perhaps you could suggest volunteering for an organization or two that she/he feels connected to. This could promote a sense of purpose and increase social interaction. My Godmother, Martha, volunteered for a major nonprofit organization on a regular basis after she retired and it helped her feel connected to people of all ages.
- Mentor. If an older adult had a career/profession that she/he is retired from they might consider becoming a mentor to share their expertise and experience. My Mentor Advisor matches mentors with startups, organizations, entrepreneurs and companies who need them.
- Place of worship. If you know an older adult who is religious or spiritual, perhaps suggest that they attend a church, synagogue or other faith-based community. Many religious/spiritual communities assist older adults in many ways, especially if hospitalized or in need of delivered meals
- Vision and hearing tests. Not being able to hear conversations is a major barrier for social connection. Same with vision. If you know of an older adult with these possible issues, suggest or assist with her/him getting tests for hearing and vision.
- Healthcare professionals. Doctors, nurses, PAs, NPs, and more, can identify isolated seniors and facilitate resources. Check in with your older loved one’s healthcare professionals.
- Counseling. Counseling for older adults can be helpful. Not just to provide someone to talk with but to provide resources and to help with problem solving. Sometimes just having someone to talk to can ease depression.
- Virtual Counseling Network is a nonprofit program that offers resources for finding help with life transitions, questions and challenges. They are available online, by phone and in person. I have no experience with this company so I can’t vouch for them.
The Friendship Line (Run by the Institute of Ageing) is a 24-hour, toll-free, loneliness call-in line that is also a suicide prevention hotline.
The Savvy Senior is full of resources for older adults.
The Campaign to End Loneliness: connections in older age
I’ve written about cyber attacks, cyber extortion using ransomware in hospitals, medical identity theft, data mining risks with health/medical apps and fitness trackers, and more. I am not an IT professional so I’ve written this for the un-indoctrinated, which until a year ago, included myself.
It makes sense to review a few basics about how to stay safe if you use email, engage in social media (Facebook, Twitter, LinkedIn, etc.) shop online, browse the internet, use health or medical apps, bank online or have smart devices in your home. Even if all you do is search on the internet for answers to health questions, these strategies apply to you.
Knowledge is power. The more you know, the more easily you can make an informed choice.
Think of your computer, smart phone, iPad, and other electronic devices like you do your home. We all want to be safe at home and most of us implement strategies to support that safety. We lock our doors and windows, install alarms, have protective dogs, and more. Consider taking steps to protect yourself in much the same way while using your electronic devices that connect to the internet or Wi-Fi.
With the advancement of technology and the Internet of Things (IoT), we are all more interconnected. That means we need to be informed about the risks of interconnectedness and learn how to protect ourselves from hackers and other cyber criminals. Technology is growing too fast for us not to implement a few basics to prevent identity theft, financial theft, hacking, malware, phishing scams, and more.
Public Open Wi-Fi
If while eating a muffin and drinking a latte at your local coffee bistro, you decide to do a little online shopping while you’re there, stop. Don’t do it. Public open Wi-Fi is not secure and most people don’t realize just how easy it is for a hacker to eavesdrop on your internet communication through the Wi-Fi and snag your personal information, including username and passwords. Your information can be exposed and retrieved by cyber criminals to commit identity theft.
Public open Wi-Fi is available to everyone in that location and no password is needed for use. It is not protected in any way. Coffee stores, hotels, gyms, universities, airports and other public places offer public Wi-Fi as a free service. It’s up to you to protect yourself.
- Be sure to set your smart phone, laptop or other device to manually select Wi-Fi. This way you choose when you want to connect to Wi-Fi rather than your device automatically connecting.
- Do not do online shopping, online banking or engage in social media if you use public open Wi-Fi. Your personal information will be at risk to hackers who can so easily eavesdrop on your activity.
- Public open Wi-Fi users should only visit secure websites with https addresses. It looks like this–https.www.samplewebsite.com
Facebook, Twitter, LinkedIn & Other Social Media Sites
“Cyber criminals often create fake profiles to befriend you on Facebook,” according to Heimdal Security. “Their goal is to get you to leak confidential information to them. Be careful about friend requests on all social media sites.”
On LinkedIn, cyber criminals create fake profiles to help themselves to your personal data, such as your connections, your email address, and your phone number. Check every LinkedIn connection request before you accept.
Suspicious connection requests look like this:
- Very few connections
- Very little info in the person’s bio.
- Generic information.
Strengthen Your Passwords
Admittedly, changing your passwords to beef them up is a big hassle. Who can remember their passwords? I know I can’t. I have them written down in a secure place. And yes, I’ve had to change my passwords more than once because I can’t remember my new passwords.
- Create a unique password for each unique account. Don’t use the same password for multiple accounts. Although I have to admit I’ve been guilty of this.
- Use a more complicated password that has the following: ! and #, numbers, upper and lower case letters.
- Don’t reuse old passwords.
- Don’t use your birthdate, telephone number or your street address. Cyber criminals can find that information on the internet. It’s common for people to use this information in passwords and hackers know it.
- Use two-factor authentication, known as 2FA. It is a two-step verification, an extra layer of security that requires not just a password and username but something unique to you.
- The rule of thumb has been to change passwords fairly often to outrun hackers. But a colleague pointed out that there is new research that unveils that changing passwords can actually decrease security. See for yourself here. Thanks to Meg Helgert for the information and this study.
Health/Medical Apps and Fitness Trackers
I don’t use these myself for security reasons. I purchased a FitBit some time ago and after reading the fine print, I returned it to the seller. FitBit, JawBone and other fitness trackers collect, share and sell consumers’ data to health insurers, employers, data brokers and others. Health/medical apps do it too.
More info in my article, How much health care data is mined without your knowledge.
Health related apps aren’t regulated by the FDA and aren’t covered by HIPAA, which means that the majority collect your sensitive data and do with it what they will. Most don’t have good privacy or security, according to PC World’s article, Why hackers love health apps.
Most of us use email in some form or another. What you might have received already and hopefully deleted, are phishing emails meant to fool you into thinking they are sent from a known business or bank. Cyber criminals make these phishing emails look real by using photos, images and logos from the original businesses. Many go undetected.
A phishing email might ask you to click on a legitimate-looking link or ask you to download an attachment.
Don’t do it.
The phony email might ask you to authenticate your username or password. You may be informed of a deposit or withdrawal and then asked to click on a link. Phishing emails lure you into giving them personal information such as social security numbers, credit card details, birth date, mother’s maiden name and more. This information can give a hacker all he needs to gain access to your accounts or to commit identity theft.
In 2013, Walmart customers were tricked into believing an email scam that requested that they update their account information urgently to keep them safe.
“Unsubscribe” Email Scam
According to the Identity Theft Resource Center, a new scam has arrived. “Savvy scammers have leveraged the power of annoying spam and dangerous phishing emails by combining them. The result is a barrage of identical looking spam emails that promise everything from weight loss to skin care products, all of which offer you multiple chances to click “unsubscribe” in order to stop receiving the emails.
Their tactic is to bombard you with these spam emails so you’ll do just about anything to make them stop. However, embedded in the “unsubscribe” link is a virus or malware that could infect your computer.
If you don’t recognize the sender, or you didn’t sign up for the emails, do not click on the “unsubscribe” link provided. Report the email as spam by clicking on the spam button on your email program.
Spam email can also include malware that allows a cyber criminal to control your computer remotely, freeze the contents and demand a ransom in exchange for the release of your personal photos and other data. More information on malware in my blog, Hospitals are sitting ducks for ransomware and other cyber attacks.
Keep Your Software Updates Current
Download your software updates on your computer, iPad, smart phone or other electronic device as soon as they become available. Or turn on the auto-download on your software updates. Software updates keep security on your device current. Updating the software on your apps can prevent 85 percent of targeted attacks. See Heimdal Security for more info on this.
Purchase Anti-Virus Software
Yes, you need it. I use Intego Mac Security. This is not an endorsement, just what my IT tech recommended. So far, my computer has been safe.
However, I did just hear from an IT person who read this blog and said that third party anti-virus software is unnecessary. You’ll have to do your own research on this as there seem to be two schools of thought.
Check Your Bank Statements Weekly
Even if you don’t bank online, you should be checking your accounts on a weekly basis. Review your statements for unfamiliar withdrawals and deposits. Alert your bank if you notice suspicious activity. Change your password immediately if you do.
Smart TVs, Smart Refrigerators, Smart Homes, Virtual Home Assistants, Smart Security Cameras, Smart Thermostats—The Internet of Things (IoT)
I don’t own any of these for a reason. I’m not against them as they make lives easier and I know people who love them. If you do purchase or already own a Smart TV or for example Amazon Echo (Alexa,) be sure to read the fine print. The voice command feature, if left on, can collect and send your voice data to a third party service that converts speech to text. Talk about a privacy issue, not to mention a creepy one. Read more about this here, Your Samsung SmartTV is Spying on You.
Please read the FBI’s warning about these Smart Devices.
I hope this helps.
Imagine you are a patient in a hospital that gets attacked by ransomware. Your medical records and other data are seized, and all users including your physicians and nurses, are denied access to them. Let’s say you are about to receive chemo, radiation, or another vital treatment.
What would you do? What can you do?
Not a whole lot, unless of course you have your own personal back up of your hospital medical records on hand. And even then the hospital may not be operable.
Think this sounds implausible? Think again. And read on.
As many as 75 percent of U.S. hospitals have been hit with ransomware in the last year. Hospitals are considered the perfect targets because they need the information on patients immediately, don’t have the necessary tools to prevent such an attack, and many haven’t taken the necessary steps to educate and train their employees on how to avoid such an attack. Many simply pay up. But not without extensive delays and having to turn patients away or evacuate patients from the healthcare facility.
This kind of cyber extortion can put patients at risk and compromise patient safety.
If this is new to you, ransomware is malicious software that seizes all data in a computer or computer network. Cybercriminals hold it for ransom until payment is made in exchange for release of the information. In a hospital, it will lock up all electronic patients’ records and other data in its computers and computer networks. The information is left completely inaccessible to medical professionals who need it for patient care. Messages are installed by cybercriminals demanding payment, usually in the form of Bitcoin, in exchange for accessibility to the seized information. Sometimes the cyber extortionists release the data after receiving the ransom payment and sometimes they don’t.
According to the FBI, “Ransomware attacks are growing in number and are becoming more sophisticated.” The FBI also reports that hacking victims in the U.S. have paid more than 209 million in ransom payments in the first three months of this year.
Malicious malware can be sent in an email to a specific person with an attachment that appears to be legitimate such as an invoice or electronic fax. Or the email can contain a legitimate looking URL which the victim clicks on and then is taken to a website that infects the computer with malicious software.
There are new cases of ransomware where cyber criminals don’t use emails at all. They seed legitimate websites with malicious code which then seizes the computer and possible other networks and back up drives.
In May of 2016 Kansas Heart Hospital was hit with ransomware and extorted twice.
In April of 2016, three Southern California hospitals, owned by Prime Healthcare Services, were attacked by ransomware. Prime Healthcare Services stated in a Los Angeles Times article that they did not pay the ransom. The FBI recommends not paying the ransom. One can understand why hospitals would pay up to get their systems and patient care running as soon as possible. There just aren’t enough tools in place for them to do much else. Some hospitals do refuse to pay the ransom and rely on back up copies of information. Still, it can take several days for them to get back to some degree of normalcy.
In March of 2016, cyber criminals attacked 10-hospital MedStar Health, located in the Maryland and District of Columbia region. The hackers encrypted the hospital chain’s computer networks so all information was frozen. The Baltimore Sun reported that the malware attacks left ten MedStar hospitals unable to access patient data and in some cases having to turn patients away.
Also in March of 2016, Methodist Hospital in Henderson, Kentucky, was crippled by ransomware and claimed to be operating in a state of internal emergency. The hospital was forced to shut down all of its computers because of the malicious malware. The message left on the affected systems via Locky malware demanded a ransom in bitcoin.
In February of 2016, the Hollywood Presbyterian Medical Center, located in Los Angeles, had their computer networks attacked by cyber criminals who demanded 17,000 in bitcoin to release patients’ records. Hollywood Presbyterian paid the ransom.
Not a cyber extortionist attack but noteworthy all the same, in July of 2015, UCLA Health was the victim of a major cyber attack. 4.5 million patients’ data was compromised which included social security numbers.
Among others, Anthem Blue Cross disclosed that 80 million customers’ data was compromised in 2015.
The list goes on.
Sen. Bob Hertzberg authored a bill in effort to make ransomware a felony. Let’s hope that passes. But I have to wonder how cyber criminals would be charged since most cyber attacks originate outside of the U.S. This is an update on a bill already passed that introduces new penalties specifically for ransomware attacks. If the update passes, cyber criminals would be fined up to $10,000 and sentenced to two, three, or four years in jail.
Seems like a paltry sum and a much-too-short jail sentence if you ask me. After all cyber extortion is basically data kidnapping that could put patients lives at risk. Under federal law extortion carries up to a 20-year sentence, depending on the circumstances. Perhaps Hertzberg’s new bill is a good start on a massive, growing problem.
Hospitals must focus on prevention of these ransomware attacks. Real time backing up of patient electronic medical records and other data is an important strategy, but it still only addresses the problems after the cyber attack has been committed. Many hospitals don’t even back up. Preparing for a ransomware attack is essential for every hospital or other healthcare facility. Many hospitals claim to have insufficient funding to pay for internal experts such as chief security officers or to enlist a solid cybersecurity company’s services.
“Educating and training all system users is crucial,” states Healthcare IT news in its article, Tips for protecting hospitals from ransomware as cyberattacks surge. “All it takes is one uneducated user.” It’s the employees in hospitals who click on phishing emails or visit corrupt websites.
It’s not just the hospitals or healthcare facilities that become victims to ransomware. Patients must be protected.
I welcome your comments.
As my husband was wheeled into his hospital room after total hip replacement surgery, I noticed a red sign on the patient’s room that was kitty-corner to his. It said, “Stop. Infection risk.” The sign included instructions about donning gloves and gowns before entering the patient’s room.
This was not a good sign.
I waited outside Jamie’s room for a few minutes as two nurses evaluated him. Two medical professionals inside the other patient’s room caught my attention. They were not clothed in protective gowns or gloves, even with the infection risk. They spoke to the elderly patient at her bedside, one with a stethoscope around his neck and clipboard in hand. I overheard them explain to her that they could not release her because of her MRSA infection and that family members had not been reached.
MRSA? I tried to calm myself. Methicillin-resistant Staphylococcus aureus is serious business. MRSA can be life threatening and causes wound infections after surgery, pneumonia, sepsis, and more.
According to the Journal of Clinical Microbiology Reviews, hospital-acquired infections are the fifth leading cause of death in the United States.
I glanced into the patient’s room again, unsure if I’d seen what I thought I had. The clinicians were in fact not wearing gowns or gloves.
According to RID, the Committee to Reduce Infection Deaths, “Clothing is frequently a conveyor belt for infections. When doctors and nurses lean over a patient with MRSA, the white coats and uniforms pick up bacteria 65% of the time, allowing it to be carried on to other patients.”
As I stood facing my husband’s room, the curtain drawn around his bed for privacy, I noticed how close the elderly patient’s room was to his. About three to four feet. I figured that she and my husband might share the same nurses. My fears spiked as I thought about how easy it would be for nurses and other medical professionals to transmit MRSA from one patient to another. In the published study, Hand hygiene for the prevention of nosocomial infections, “Healthcare workers’ hands represent the principal route of transmission of nosocomial pathogens.” Staphylococcus Aureus (MRSA) can survive for over 2 hours on the hands and is found in 10-78% of staff.”
Minutes later, I stood by Jamie’s bed, touching his hand. He looked weary, in pain.
“You okay?” I asked.
I didn’t mention the MRSA patient next door as I didn’t want to worry him. I mulled over how I was going to handle this with his nurses, how to approach them so I could maintain a cordial relationship. That relationship was crucial to his care. But I also wanted him safe.
Nancy, Jamie’s registered nurse, soon entered the room and introduced herself. We chatted about my husband’s surgery, his care, and I asked about dinner for him since he hadn’t eaten since midnight the night before. Nancy was very friendly and exuded an air of confidence, which put me somewhat at ease. I decided to wait to address my concerns about the patient next door.
To say that I was worried about Jamie would be an understatement. His first hip replacement surgery on the other hip 14 months ago had not gone well and had to be redone. After severe pain did not let up for five months after that surgery, we’d met with several orthopedic surgeons for other opinions. Each one recommended revision surgery. We chose the surgeon who performed the most hip replacement surgeries and revision hip surgeries, who had excellent training and education, but who was also a patient-centered physician. He answered all of our questions. He took the time to explain what needed to be done. He made the effort to get to know Jamie, to establish a relationship.
Seven months ago, Jamie’s revision surgery was expected to take about an hour and a half. It turned into a five-hour operation because the previous hip replacement was such a mess. The new surgeon had quite a bit of trouble withdrawing the stem. It would not budge. He had to surgically cut a keyhole into my husband’s femur to pop it out. He was forced to insert a longer stem because of the problems caused by the previous surgery. This surgeon explained in detail what had happened, and that the recovery would be extended.
Jamie’s recovery from the revision surgery was long and arduous. As a previous hockey player for 25 years on a hockey league, and a skier, motorcycle rider and all around athletic guy, he struggled with losing much of what brought him joy.
Because of Jamie’s life-long physical activity, his other hip was also in very bad shape. All of the orthopedic surgeons we met with said that it too would need to be replaced as it was bone on bone. Ongoing pain in the natural hip prompted the current surgery.
Normally, a patient with MRSA in the hospital room next door might not have prompted as much concern on my part. But Jamie had been through so much—3 years of chronic pain. 3 surgeries. I just wanted him to get his life back without complications.
Nancy was very attentive to Jamie and brought him pain medication almost immediately when she realized he was suffering. She also informed us that dinner was on its way. I liked her already and thought about what I could bring the next morning for her and the other nurses that might show our appreciation for their care.
But the MRSA issue burned in my brain. As soon as I sensed we had developed a good rapport, I asked her the question. “The patient next door,” I said, “She has MRSA, right?”
Nancy appeared a bit startled. “How did you know that? “
I explained that I’d seen the sign on the door and overheard the medical professionals’ conversation in her room as I’d waited for Jamie to be evaluated.
“Is my husband at risk for contracting MRSA since her room is so close?” I asked gently, trying to conceal my worry. I apologized for asking, not wanting to doubt her professionalism.
Nancy explained the protocol for donning protective clothing and gloves before entering the other patient’s room and outlined what needs to happen upon leaving it. She added, “We also use the hand sanitizer every time we come into your husband’s room and again before we leave.”
It had been a while since I’d done research on hospital-acquired infections for both of my books, The Take-Charge Patient and Critical Conditions, but I didn’t think that hand sanitizers killed MRSA. I blurted out, “Does that hand sanitizer kill MRSA?” See this article, The FDA Wants Proof Hand Sanitizer Works.
Nancy hesitated for a split second, motioning to the hand sanitizer dispenser on the wall. “Yes, it does.” She probably hadn’t encountered many loved ones who asked that question. And then she whispered to us, “I’m not taking care of her anyway. I won’t be going into her room.”
Two days later, Jamie was home from the hospital and recovering. He still has no signs of infection. A nurse visits him twice a week and he has in-home PT three times a week.
A week after the surgery, I felt able to do some research on hospital-acquired infections. The CDC states that hospital-acquired infections affect 1.7 million people annually and kill 99,000 people each year. A common statistic that many are familiar with.
But what I discovered that was new to me is that hand sanitizers used in hospitals must have a 65%-100% alcohol content to be effective against MRSA, according to the published study, Effectiveness of various hospital-based solutions against community- acquired methicillin-resistant Staphylococcus aureus. I have to wonder if all hospitals provide hand sanitizers with that level of alcohol content. Hand washing is still considered the gold standard for preventing transmission of infection. But with understaffing, lack of time and patient emergencies, it’s a wonder nurses have time to hit the restroom.
Then, I looked up the patient safety grade of the hospital Jamie had been in. I could have researched this before his surgery but I’d decided against it.
My husband’s surgeon has privileges at that hospital and could not have performed the surgery in another facility. We were committed and very confident in this surgeon. My husband was not going with anyone else because of a hospital’s infection rates. He had been through too much. Besides, I knew this hospital to be much better than the other one covered by our health insurance.
Hospital Safety Score for the hospital my husband was in?
However, it was a relief to see that their safety scores for MRSA were higher than most.
Beth Gainer’s book, Calling the Shots in Your Medical Care, is a must-read for every patient and caregiver. Written with a straightforward and compelling voice, Gainer offers sound advice to get the best medical care. She should know. She is a breast cancer survivor who lived through and overcame many challenges in her medical journey.
Calling the Shots in Your Medical Care focuses on the all-important doctor-patient relationship, showcasing the quality of that relationship and it’s direct connection to good medical care. Through interesting stories, Gainer illustrates how to find a truly great doctor. We recognize physicians who treat patients with respect and who value patient participation in care. Armed with her own strategies and checklists, Garner finds some amazing doctors to treat her.
Through the author’s journey, we also recognize arrogant doctors who don’t listen to patients, those who aren’t interested in a collaborative relationship with patients. Gainer admits that a patient-centered, caring physician is not easy to find but emphasizes the importance of locating one.
The author’s many triumphs throughout her medical journey are not without horror stories and common frustrations with our healthcare system. The way Gainer handles the pitfalls had me cheering for her. I’ve not read a book thus far that empowers a patient as much as this one. She encourages patients to listen to their gut instincts, to speak up, to become informed, and to engage in care.
Having fully researched a treatment to prevent a reoccurrence of breast cancer, Gainer shows us by example how to achieve “doctor buy-in” on the medical treatment she believes is best for her. At the helm of her care, Gainer works in partnership with her chosen medical professionals. “A wonderful physician will also be open to the patient’s input,” she writes. This is key to patient-centered care and Gainer knows it.
The author admits to being somewhat intimidated by certain doctors, just like the rest of us. Her story about her oncologist who encourages her to speak up, to stand for herself as a patient, is the best example of patient empowerment I’ve read. Gainer is realistic about the demands and frustrations of dealing with time-pressed medical staff but gives herself permission to ask for what she wants anyway. Patients need to hear this more than ever now.
Beth Gainer’s personal journey with breast cancer also opens the door to her personal suffering with treatments, revealing just how difficult it can be to undergo chemotherapy and surgery with all the trappings of a complex and often frustrating medical system. Her story is one of triumph.
Calling the Shots in Your Medical Care is both an emotional and captivating read. It is packed with effective strategies for patients to get the best care while maintaining their sanity.