About Martine

Martine Ehrenclou, M.A., is an award-winning author, advocate and freelance journalist. Her newest health book, The Take-Charge Patient: How You Can Get The Best Medical Care, winner of 18 book awards, empowers readers to become proactive and effective participants in their own healthcare. Through her books, lectures, media interviews, published articles and blog, Martine reveals insider information on how to be an engaged, informed patient to receive increased quality of care.
28 09, 2016

Physician Burnout—doctors, nurses and patients are getting caught in the drain.

By | September 28th, 2016|Current Health Topics|0 Comments


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.

19 09, 2016

Loneliness and Isolation in Older Adults is an Epidemic–tips to help

By | September 19th, 2016|Current Health Topics|0 Comments

olderwomanAgeism 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

  1. 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.
  2. 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.
  3. 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.
  4. 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
  5. 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.
  6. 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.
  7. 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.
  8. 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.

More Resources

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

Overmedicating the Elderly Patient: 10 tips for caregivers to protect patients 

Older patients need geriatric emergency rooms 

Social Isolation for seniors shortens lives

30 06, 2016

The MRSA Patient in the Hospital Room Next Door

By | June 30th, 2016|Current Health Topics|0 Comments

hipreplacementAs 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.

Jamie nodded.

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.”

I exhaled.

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?

Grade C.

However, it was a relief to see that their safety scores for MRSA were higher than most.


28 06, 2016

Calling the Shots in Your Medical Care by Beth Gainer

By | June 28th, 2016|Book Reviews & Awards, Current Health Topics|0 Comments

13563483_10206104729407913_459234551_nBeth 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.

Calling the Shots in your Medical Care will be available July 5, 2016 and can be found at Beth Gainer’s website, and on Amazon.


12 06, 2016

Cash Pay Patients: tips to beat high deductible health insurance plans

By | June 12th, 2016|Current Health Topics|0 Comments

patientsmedbillMany of us now have high deductible health insurance plans, which makes us “cash pay” patients until we meet our deductibles. The higher the deductible, the lower the monthly premium. If you have a high deductible and don’t consume much medical care, you are most likely a cash pay patient. You might even avoid medical care because of the out of pocket cost. I know I have.

As health insurance premiums increase each year, so do deductibles. Across the country, rates have increased 20 to 40 percent and up, making it difficult for many of us to afford anything but a high deductible plan. I talked with a friend yesterday who has a $9,000 deductible. She has a torn meniscus. She is avoiding the surgery because she isn’t even close to hitting her plan’s deductible. I suggested she try asking for a “cash pay” price from her surgeon and the hospital or surgery center where her procedure would be performed.

Negotiating cash pay prices for medical treatment has become a common practice. Even if you have health insurance you may want to pay cash. Often a cash pay price for medical care can be less than what you’d have to pay if your health insurance gets involved.

But be aware, cash pay discounts only work if your provider does not submit your bill to your health insurance company.

According to Gerald Kominski, director of the UCLA Center for Health Policy Research “If your insurance has a high deductible you should always ask for the cash price.”

After my family’s past health insurance company pulled out of the health insurance market at the end of 2015, we went with a Blue Shield plan. Our premium increased $125 a month and the plan covers less. Our deductible is higher. And they deny most medications.

This year, Blue Shield denied a medication I’ve been taking for years. Even after my doctor filed an appeal, they refused, suggesting I try similar medications that are obviously less expensive for them and not what my doctor prescribed.

I decided I was not going to let Blue Shield dictate my treatment if I could help it. I spoke to my pharmacist and asked what the cash pay price would be for the medication without submitting to our health insurance. The quote was too expensive to pay on a monthly basis. So I called a few pharmacies and asked for their cash price for my medication. I took the lowest price back to my pharmacy and asked if they would match it. They agreed.

You too can shop around for cash pay prices and not just for medications, but for other medical services. For example, if you need an MRI, call a few imaging centers and ask for their cash pay price. Be sure you make it clear you do not want it submitted to your health insurance. You can then negotiate with the provider of your choice.

Here’s how:

  1. Offer to pay up front at the time of service in exchange for a discount cash pay price. Medical providers wait long periods to get paid by health insurance companies and some welcome being paid quickly.
  2. Offer to pay the equivalent in cash to the price your doctor or other healthcare provider might receive from your health insurance company. What many patients don’t know is that health insurance companies don’t pay what doctors or other providers bill. Health insurance companies negotiate a reduced fee so the provider is paid quite a bit less than what is initially invoiced. In anticipation of the reduced payment from health insurance companies, doctors and other medical providers increase the amount of the patient’s bill, according to Medical Billing Associates. Cash pay patients will be charged the same fee unless the patient negotiates a cash pay discount.
  3. Do not use a credit card as credit card companies tack on a fee, charging the end user a percentage of the bill. Offer to pay in cash, check or cashier’s check. My husband’s anesthesia bill from his surgery was paid by our past health insurance company with a credit card. The anesthesia group tacked on a $45 additional fee for credit card processing onto our bill. I put a stop to that. So can you.
  4. Go to Healthcare Blue Book, Clear Health Costs or New Choice Health  and look up the desired medical service to get an idea of how much local doctors and hospitals charge for what you need. You might find that there are vastly different prices for procedures done in academic medical centers vs. surgery centers etc.
  5. Negotiate a cash price before you have a medical procedure. Be sure to get the name of the person you negotiated with at the medical provider’s office, and the exact price and date of the discussion.
  6. Ask about cash pay prices for other providers involved in your surgery or procedure. I’ve found that anesthesiologists are often not covered by health insurance. If you are negotiating a cash price don’t forget to ask to speak to the anesthesiologist too.
  7. You can negotiate a cash pay price after a procedure or treatment, but it’s easier ahead of time. If you receive medical bills from a hospital, per say, you can still ask for a discount. Try this: “I can pay 30% of the bill now if you will write off the rest.” If they do not agree, they might come back with an alternative reduction you find acceptable.

If you think that negotiating cash pay prices for medical care has an unseemly quality, you might consider how unseemly it is for health insurance companies to raise their rates at the current pace, how they increase the availability of high deductible plans while making lower deductible plans’ premiums unaffordable to most, all the while narrowing your choice of doctors and hospitals on available plans.

The drawback to “cash pay” for medical services, is that not submitting your claims doesn’t allow you to meet your deductible. If you anticipate a major medical expense, such as a major surgery or hospital stay, you might consider putting your medical services through your health insurance so your high deductible is met. That way the expense has a good chance of being covered. Minus the co-insurance, co-pay, and other deductibles, that is.

Resources for Discounted Medications

Medical Billing/Dispute Advocates

Medical Billing Advocates of America

Advocates for Arbitration, Lack of Access to Care, Medical Debt, and more.

Patient Advocate Foundation

For more information, please go to

5 05, 2016

Cyber IN-Security: your medical records are gold mine for cyber criminals

By | May 5th, 2016|Current Health Topics, Data Security|0 Comments

CyberInsecuritySome say privacy is an illusion. I hope that isn’t true but I do know that our medical records are not safe. Why do I care? Because our medical records contain our social security numbers, health insurance information, our home addresses, phone numbers, emergency contacts and their phone numbers, our email addresses, possibly our driver’s license numbers, and likely credit card payment information if you’ve ever paid your co-pay with a credit card. I know I have.

Your medical record is worth 10 times more to a cyber criminal than your credit card number. And with healthcare’s mandatory transition to electronic medical records, cyber thieves have taken full advantage.

If you think major institutions are immune to cyber attacks, think again. You might recall the cyber attacks on our U.S. government. One in particular compromised personal information on 22.1 million people and 5.6 million fingerprints were stolen.

No doubt you’re aware of the major ransomware attacks on hospitals across the country where cyber criminals seized patients’ electronic medical records and held them for ransom to be paid in Bitcoin. See article here

According to the Ponemon Institute’s Fifth Annual Study on Medical Identity Theft, 90 percent of healthcare organizations have been hacked, exposing millions of patients’ medical records.

You probably remember the major cyber attacks on the three major health insurers, Blue Cross Blue Shield where over 10 million patients’ medical records were exposed.

According to Modern Healthcare, nearly one in eight patients have had their medical records exposed in breaches in the United States. Since that article was published in 2014, that number has likely doubled.

You might be asking yourself, “What could cyber criminals do with my personal information housed in my medical records?”

Cyber criminals can monetize your personal information to obtain credit cards or loans, to commit tax fraud, send fake bills to insurance providers, acquire government benefits from Medicare and Medicaid, and much more. Your personal information can also be used to purchase healthcare services, prescription medications and medical equipment. It can also be used to obtain your credit report.

The above can also corrupt your medical history with inaccurate diagnoses and treatments.

According to the same Ponemon Institute study, 65 percent of medical theft costs each victim $13,500 to resolve the crime.

This is pretty scary stuff. I’ve heard from friends and colleagues that they can only take in small amounts of information because it’s so frightening and they feel it’s beyond their control.

There is something you can do.

It is up to doctors, hospitals, and other healthcare organizations/companies to secure their electronic medical records, back up hard drives, use secure cloud platforms (if there is such a thing,) encrypt emails, update software and more. Many just aren’t doing it.

According to the HIPPA Breach Notification Rule, a hospital or health insurance company that has been victim to a security breach, must inform patients, if more than 500 people have been affected. Unfortunately most do not. Patients find out about errors on their Explanation of Benefits (EOBs,) in letters from collection agencies, by finding mistakes in their health records or on their credit reports.

As a patient you are at risk. So am I. And we are all patients even if we just see a physician once every year or two. Had a baby? Had a vaccine? Been treated for the flu? All of us are patients and have been since we saw pediatricians as kids.

What You Can Do to Protect Yourself

  1. Read your Explanation of Benefits (EOBs) that come from your health insurance plan. Call your health insurance company if you do not recognize a charge. Check for total amount covered and amount paid.
  2. Get copies of your medical records from doctors and review them for errors. Look out for misdiagnoses, incorrect pre-existing conditions, procedures you didn’t have, incorrect treatments, allergies you weren’t treated for, and more. If you have trouble understanding your medical records, ask your doctor or his/her nurse to help you understand the information.
  3. Monitor your credit reports and billing statements for errors.
  4. Do not give out your social security number to anyone unless absolutely necessary. Often the last four digits will do.
  5. If you have your medical records or any personal information on your smart phone, be careful about using public Wi-Fi. If you send or receive an email or browse the internet while using public Wi-Fi, a hacker can eavesdrop on your transmission and gain access to the information on your device.
  6. Be wary of health apps. Generally, apps are not secure. See article here
  7. Be wary of public Wi-Fi. This includes any hospital. If you are a patient or visitor at a hospital, make sure the Wi-Fi is encrypted. If it is encrypted it will require a WPA or WPA2 password. Even if encrypted, think twice about sending any personal information via email or text while you are there.
  8. Set your laptop or computer to manually select the public Wi-Fi network in the healthcare facility you are in.
  9. Look for web addresses that begin with https. These are more secure.
  10. Do not share personal information on file sharing sites. Often they are not secure, according to Becker’s Hospital Review, 10 Ways Patient Data is Shared With Hackers.

The FBI recommends:

1. Keep your firewall turned on.

2. Install and/or update your antivirus software.

3. Keep your operating system up to date.

4. Be careful what you download.

5. Turn off your computer at night.


For more information on cyber attacks, cyber security, data mining and patients medical records, see the following:

Rapid Increase of Cyber Attacks

Patients’ Medical Records hacked at Alarming Rate

Healthcare Data Mining: is your privacy being breached?



26 04, 2016

Who Besides the Cleveland Clinic Could Use Improv Teaching Strategies?

By | April 26th, 2016|Current Health Topics|0 Comments

BB-closer-Headshot-1-13-Cherations-350 x 350Guest Post by Beth Boynton

MedCity news reporter, Neil Versal’s article, Improv training helps Cleveland Clinic improve MD communication, describes Cleveland Clinic’s recent workshop to teach clinicians how to improve patient engagement!

It is super exciting to hear about because it means that powerful experiential teaching methods inherent in improv are reaching mainstream healthcare! Teaching methods that can help us with recalcitrant issues such as; patient safety, workforce health, and toxic cultures. And these claims are supported by research presented at the National Academies of Practice this past April by Candace Campbell, DNP, MSN-HCSM, RN, CNL, FNAP. Dr. Campbell’s poster presentation summarized her USFCA Doctoral Thesis entitled, “Improv to Improve Interprofessional Communication, Team Building, Patient Safety, and Patient Satisfaction”.

As a specialist in communication and collaboration, I’ve been integrating interactive improv activities into workshops with nurses for over a decade and in the last few years have decided more of an improv focus. Healthcare professionals already know what respectful listening and speaking up is supposed to look like, but we don’t the opportunities to practice building the skills and relationships we need. People are tired of taking typical communication courses and if we look at our patient safety data communication is a pervasive and chronic problem!

I had the pleasure of attending the first “Medical Improv” Train the Trainer at Northwestern University in 2012 led by professor and improvisor, Katie Watson, JD who has developed a curriculum for medical students.

I take improv for personal and professional development and have for over ten years. The activities are a lot of fun and I’ve grown a lot personally and professionally! We can take the emphasis off of comedy or performance and put it on the process, there is a rich gold mine of learning! In fact, you can’t participate in an improv activity without developing the emotional intelligence and interpersonal skills that we desperately need in healthcare!

 It seems like a ‘no-brainer’ that all hospitals, clinics, and nursing homes should get some of this training, right? Ah yes, but we need more research, more trainers, more money, which could take years, right?


We can create a train-the-trainer resource this year through the crowdsource funding project, “Improvoscopy: Serious Play for Safe Care”. Please take a few minutes to explore the idea and consider a contribution. We don’t need to wait!


Beth Boynton, RN, MS, author of Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers, is a speaker and medical improv trainer. More information about her work can be found on at and she can be contacted at

4 04, 2016

Why We Need Build an Emotionally Intelligent Healthcare Workforce & an Innovative Way to Do It!

By | April 4th, 2016|Current Health Topics|1 Comment

Guest Post

By Beth Boynton, RN, MS

BB-closer-Headshot-1-13-Cherations-350 x 350As a consultant and author specializing in teaching emotional intelligence (EQ) and communication skills to healthcare professionals for over a decade, I can attest to the critical need for and barriers we face in developing them. Further, it is important for all stakeholders to understand these challenges so that we can work together effectively for positive change. In this post I want to discuss these issues, share an exciting crowdsource project, and ask for your help. (If you already believe that promoting EQ will help us solve problems in safety, patient experience, and workforce harm, skip down to the section on “Good News”!)

EQ is all about self and others. It includes the ability to show empathy, honor other points of view, and empower others, and acknowledge accountability. In a service industry so focused on human beings it seems obvious that nurses, physicians, and other healthcare professionals should be proficient in this skillset. Yet many are not and given the ‘high-stakes’ work of healthcare, ensuring the workforce has related training is a call-to-action for all of us.

How Does Emotional Intelligence Manifest in the Workplace?

Whether highly developed or lacking, EQ is an underlying theme in human interactions. For instance, as an RN, I need to show empathy for patients and be able to listen to their concerns not only to make clinical assessments, but to understand their needs and worries. I must also be self-aware of my own limitations associated with fatigue, overwhelm, and/or tragedy. I need to trust that I will be respected and heard if I report a problem and able to set limits, ask for help, and delegate tasks respectfully while in an environment where my limits are respected, help is available, and there are staff to delegate to. I need to be respectful of others’ limitations and be in tune with their social cues. Also, my ability to give and receive constructive feedback is fundamental to ongoing quality improvement which is a cornerstone to a culture of safety.

While physicians and other healthcare professionals have different roles and perspectives, this complex realm of EQ poses similar needs and challenges. For example, a physician must be able to show confidence, authority, and directive leadership while always being open and respectfully responsive to input from others.

What Happens When Emotional Intelligence is Lacking?

 In a general sense, individuals who lack EQ are not able to take good care of themselves and/or work effectively and respectfully with others. This results in poor communication, teamwork, and leadership which in turn contribute to mistakes, poor patient experience, and/or harm to the workforce. Here is a some relevant data to drive this point home.

Patient Safety



Patient Experience Surveys


  • The Hospital Consumer Assessment of Healthcare Providers and Systems’ (HCAHPS) surveys that measure patient experience are rich with feedback about interactive behaviors of staff.   Of the 32 items surveyed, 14 are directly related to communication and emotional intelligence such as, “During this hospital stay:


…did nurses treat you with courtesy and respect?

…did doctors listen carefully to you?

…did nurses explain things in a way you could understand?”

 Workforce Harm

 “Through the Eyes of the Workforce” is a 2013 report from the National Patient Safety Institute that details physical and psychological harm experienced by the healthcare workforce. Some statistics taken from the report include:

  • Health care workforce injuries 30 times higher than other industries
  • 76% of nurses in national survey indicated that unsafe working conditions interfere with the delivery of quality care
  • An RN or MD has a 5-6 times higher chance of being assaulted than a cab driver in an urban area
  • Lack of respect is a root cause, if not THE root cause, of dysfunctional cultures 95% of nurses report it; 100% of medical students; huge issue for patients.

These important issues are often treated as separate phenomenon yet when we consider EQ, a common and underlying problem emerges: we are not doing a very good job working together and the results are very serious!

 Challenges to Developing Emotional Intelligence

As essential as it is to promote EQ, there several challenges we face in training healthcare professionals.

First, is a persistent lack of time. Medical and nursing educational programs are so packed with scientific and clinical studies that there is little time for learning EQ beyond cursory efforts. The lack of time for developing EQ persists once students graduate and begin practice. High-stakes, high-stress clinical issues are always the priority. Time for managing conflict, offering constructive feedback, or coping with tragedy, is chronically unavailable. Some of us may even use this perpetual state of reaction to avoid doing deeper work!

Compounding this lack of time is the need for psychological safety in order to develop and practice the skills. The same environment noted above is not at all conducive to taking emotional risks that can be involved in speaking up and listening. Since speaking up requires the risk of being more accountable and listening requires a sharing of power, either can be very difficult for someone who does not have a confident sense of self. The psychological risks of trying out new behaviors are made even more difficult by blaming or bullying cultures.

Another challenge we face is that the kind of expertise necessary to build EQ is very different from memorizing scientific facts or researching data. Teaching EQ requires skills in facilitation, coaching, conflict management, and the ability to create a safe learning environment. A skill-set not common in clinical leaders.

And so we have a lack of skills, a lack of expertise to teach them, and workplace environments that are too risky to practice them. A perfect storm for the longstanding issues we’re facing.

There is Some Good News

A new kind of experiential teaching called Medical Improv is a growing field of interest. A speicific form of applied improvisation and in my experience, one of the most effective ways to teach EQ, communication, teamwork, and leadership.   If we can help nurse, physician, and administrative leaders learn how to teach some of the fundamental improvisational activities we could create a far-reaching rippling effect.

And that is exactly what Improvoscopy: Serious Play for Safe Care is designed to do. This project will involve filming improv workshops and then editing video bites that emphasize teaching strategies and learning opportunities.   These will be used to build an online library of videos and lesson plans that will empower them to train others. Activities for building EQ can then be integrated into staff meetings, orientation, strategic planning, and clinical inservices. Voila, powerful experiential learning without a huge time or financial commitment! Please consider checking out Improvoscopy project, sharing the idea, and contributing at any level! Thank you very much and if you have questions, please let me know!


Beth Boynton, RN, MS, author of Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers, is a speaker and medical improv trainer. More information about her work can be found on at and she can be contacted at

10 03, 2016

Hello Barbie? New toy puts kids at risk.

By | March 10th, 2016|Current Health Topics, Data Security|0 Comments

CyberhackThere’s a new Barbie in town. There’s nothing appealing about Hello Barbie, developed by Mattel. In fact it’s downright Orwellian. Well-meaning parents, grandparents and other loved ones might not know what they are getting into when they give Hello Barbie to a 6 to 8 year-old-child.

Hello Barbie has a microphone and speaker that allows it to capture and engage in conversations with your child. This is no wind up doll from decades past that spewed pre-recorded greetings.

All your child has to do is press a button on the Hello Barbie’s belt buckle and talk into the speaker. A recording of your child’s conversation is then transmitted through your Wi-Fi connection to a company called ToyTalk. Speech Recognition Software converts the audio recording of your child into text. Artificial intelligence software allows Hello Barbie to respond to your child based on keywords extracted from your child’s words.

Hello Barbie is like a baby monitor that talks back. Remember the hackers who hacked into baby monitors and scared the living daylights out of the children and the parents? See article here. Each one was accomplished by hacking each family’s Wi-Fi.

Hello Barbie collects every detail of what your child says to it and saves it on a cloud based storage platform. The information is used to create personalized conversations with your child. See Newsweek article, Hello Barbie, Your Child’s Riskiest Christmas Present.

Not concerned yet? Read on.

Mattel and ToyTalk capture popular topics your child talks about to Hello Barbie. For example, your daughter or son confesses to the doll that she/he wants to see the new Disney movie coming soon to theaters. Hello Barbie may have thoughts about upcoming local showings of that Disney movie.

Getting the picture?

Does this remind you of how social media sites and Google insert ads according to your online searches and preferences on the internet?

It gets worse.

Third party vendors are also privy to your child’s captured data through Hello Barbie and transmitted to ToyTalk, according to their privacy policy. See ToyTalk Privacy policy here.

Parents have to download a mobile app and connect to Hello Barbie through their wireless network (Wi-Fi.) In essence, parents grant their permission for their child’s data to be stored, translated into text and shared with third party companies.

That is if parents read the fine print.

Another disturbing angle is that parents have full access to all of their child’s audio conversations with Hello Barbie. But to gain access to their child’s recorded inner secrets, they must allow ToyTalk to hold on to the information.

To say that this is an invasion of the child’s personal privacy is an understatement. It’s worse than reading a diary.

Even more disturbing, is that parents can also share their child’s personal conversations with Hello Barbie on Facebook and Twitter with a simple push of a button. This just isn’t right. Posting a child’s personal conversations on Facebook or Twitter is a violation of a child’s privacy. What 6 or 8 year old can grant permission to a parent to post his/her conversations with Hello Barbie on social media and understand the repercussions? Some parents might not think that their children have rights but I do.

There’s something else even more sinister that you have to consider regarding Hello Barbie. Given the number of cyber attacks on large banks, Sony, the U.S. government, health insurance companies, hospitals and more, what is to stop hackers from retrieving information from your Wi-Fi network through which your child’s conversations are transmitted? What stops a hacker from hacking into the server on which your child’s data is stored?

Imagine a 6 year-old child’s conversations with Hello Barbie. Most likely, information would be shared about where he/she lives, who he/she lives with, the school the child attends, names of friends, and more. Would you want your child’s personal conversations stored on ToyTalk’s servers? No server is immune to hacking no matter what companies claim.

What about parents who don’t read the fine print about Hello Barbie’s risks and simply download the app and connect it to the Wi-Fi? They won’t know that their child’s data will be transmitted not just to ToyTalk’s servers, but also shared with overseas companies that do not have the same privacy laws that we do in the United States. See ToyTalk privacy policy here.

This reminds me of the new “Smart TVs.” Samsung makes one that actually eavesdrops on the owner’s conversations. If you have a “Smart TV” that is connected to the internet, you can flip a switch to turn on the voice recognition feature that allows the TV to follow your voice commands, instead of using the remote control. That feature allows the “Smart TV” to listen to everything you say even if you don’t want it to. Your words are then processed by the television and then transmitted to a third party. Even Samsung warns, “Please be aware that if your spoken words include personal or other sensitive information, that information will be among data captured and transmitted to a third party through your use of Voice Recognition.” See link here.

Like Samsung, Hello Barbie also uses Voice Recognition software. Why wouldn’t the same warning apply to the doll?

Child privacy advocates don’t like Hello Barbie either. The Campaign for a Commercial-Free Childhood has launched a campaign it calls #HellNoBarbie that warns parents about the toy. They are concerned that a child’s conversations are going straight to the advertisers. They might be right.

Personally, I would not buy a Hello Barbie for any child. Not just because I think it’s creepy, but data can be extracted from any number of servers through the storage and sharing of that information and used for a number of nefarious purposes.

8 03, 2016

MONEY Interviews Martine Ehrenclou: 13 Smart Ways to Save on Prescription Drugs

By | March 8th, 2016|Current Health Topics|0 Comments

13 Smart Ways to Save on Prescription Drugs 
Kara Brandeisky @karabrandeisky Feb. 29, 2016

Save 40% or more on the medications you need.

Your medicine may come with a new side effect: financial pain. Prescription-drug spending grew 12.2% in 2014—five times as fast as the year before—according to the Centers for Medicare & Medicaid Services. And the sickest Americans bear the biggest burden. Some 43% of those in fair or poor health say it’s somewhat or very difficult to afford their medications, and 37% say they’ve skipped out on filling a prescription because of cost, according to the Kaiser Family Foundation (KFF).

What has changed? Generic drugs, long an affordable alternative to name-brand medicines, have become part of the problem. The average price of the 50 most popular generic drugs increased 373% between 2010 and 2014, according to OptumRx, a pharmacy benefit management company. One culprit is consolidation: After a decade of mergers, three big companies now control 40% of the generics market, says Gerard Anderson, professor at the Johns Hopkins Bloomberg School of Public Health. Weaker competition means drug companies can charge your insurer more. Meanwhile, pricey new miracle drugs—like hepatitis C treatment Sovaldi ($1,000 per pill for an 84-pill course)—are also a key factor forcing up overall medication costs.

In response, insurers are making consumers pay more, and work harder, to get their prescriptions—if the drugs are even covered. “We’re seeing plans limit the choices of drugs that are available,” says Sandy Ageloff, senior consultant with Willis Towers Watson.

Fortunately, there are plenty of ways for you to save. By making strategic changes in the medications you take (with your doctor’s okay, of course), the places you buy them, and the insurance plan you elect, you may be able to shave 40% or more off your total prescription-drug costs this year. Here are the steps you need to take.


1. Substitute generics for name brands.

First things first: If you haven’t already, ask your doctor if you can try any generic versions of your prescription meds. Despite recent price increases, the savings can still be immense. On average, Americans on employer plans could have shelled out as much as 80% less in co-pays in 2015 by switching from a branded drug to a generic, according to KFF data. “The evidence is very strong that generics work just as well,” says American College of Physicians president Wayne J. Riley.

2. Combine pills—or split them.

If you are taking several medications for the same condition, ask your physician if there’s a single pill that would do the job. For example, your insurer could make you pay a combined $100 or more a month to get a brand-name beta-blocker and a brand-name thiazide diuretic to treat high blood pressure, Riley says. But most people, he says, can sub in a generic combination pill containing both medications, which will probably have a co-pay of less than $15.

Alternatively, you might be able to save money by splitting some pills, Riley says. You’ll need to check with your physician, because not all doses can be divided safely—but once you’ve gotten the green light, ask for a prescription for half as many double-strength pills. Then buy a pill splitter and cut the tablets in two.

3. Check the formulary for your insurer’s favorites.

The list of medications that any given drug plan will cover—called a formulary—has gotten much more complicated. As little as 15 years ago, most plans had no more than two tiers, or price categories. The two-tier plans would charge you one co-pay for generics and a second, higher one for brand-name drugs. By 2015, however, 81% of workers had three or more tiers in their prescription-drug benefits plan, and 23% had four or more, according to KFF. Obamacare and Medicare plans have multiple tiers too.

Generally, the higher the tier, the more you pay. While first-tier (usually generic) drug co-pays were just $11 on average in 2015, fourth-tier co-pays averaged $93 per prescription.

And co-insurance—in which you pay a fixed percentage of the price, rather than a set dollar amount—could push your out-of-pocket costs even higher. Among plans with three or more tiers, 40% required that patients pay co-insurance on pricier fourth-tier drugs, putting an average 32% of the cost on your shoulders.

“It can make for some confusion at the pharmacy counter,” says Sharon Frazee, vice president of research and education at the Pharmacy Benefit Management Institute (PBMI). “If you don’t know where the drug sits on the formulary, you don’t know how much you’re going to be charged.”

Plans use tiers to lower costs. Your insurer will save money if you switch to a cheaper, clinically equivalent drug. The plan may also have negotiated better prices with one manufacturer by promising to charge more for the competition.

Either way, many plans offer incentives to switch. Show your doctor your formulary list and ask if there’s another drug in a lower price tier that would work just as well for you.

4. Jump through your insurer’s hoops.

In 2015, almost 70% of employers required, for at least some drugs, that you try over-the-counter, generic, or lower-cost versions before insurance would cover the pricier alternatives, according to a survey from PBMI. More than half of all employers required such “step therapy” for cholesterol-lowering drugs, for instance, up from 38% in 2010. This process can make it tricky for patients to get the expensive drugs their doctors have prescribed.

“A lot of health insurance companies are requiring that patients try three medications before they can get the one that their doctor originally recommended,” says health care consultant Martine Ehrenclou.

If your drug has such restrictions, you’ll get the bad news when you go to the pharmacy to fill your prescription. Work with your doctor to try the alternatives; if you ignore the rules altogether, you could get stuck with the full bill for your medication.

What if you have already tried the treatments your insurer is pushing? “You don’t have to start over,” says Katy Votava, founder of health insurance consulting firm Goodcare. Go to the drug section of your insurer’s website. You can send your doctor’s staff the necessary authorization forms or, in some cases, initiate the process yourself, says Votava. Your insurer should spell out the kind of documentation you’ll need.

5. Ask your plan to make an exception.

Your plan might waive restrictions, pay for a drug that’s not on its list, or charge a lower co-pay if your doctor says a specific medication is necessary.

For example, when cholesterol-lowering drug Lipitor went generic, many plans refused to cover the brand-name version or charged a higher co-pay, says Tatiana Fassieux, board chair of California Health Advocates, a Medicare advocacy nonprofit. But some people couldn’t take the generic because they were allergic to the binding additive, so plans let them take branded Lipitor or pay the generic co-pay for the branded drug.

Ask explicitly for an exception: You again go to the drug section of your insurer’s website, but this time look for a medication exception request. Give it to your doctor’s office to complete, says Riley of the American College of Physicians.

Request denied? You have the right to both internal and external reviews. Your plan’s explanation of benefits document will tell you whom to contact.

For all Medicare Part D plans, call your provider and ask to have the exception form sent to your doctor, Fassieux says. If your request is rejected, you can appeal.


6. Use mail-order options.

If you don’t use mail order for common maintenance medications, you’re probably overpaying. More than 90% of employers offered the service in 2015, and almost a quarter of those required it for at least some drugs, PBMI says. Processing can take a week or more, so when you’re starting a new medication, ask your doctor for one 30-day prescription to fill locally plus a 90-day script for mail order, Riley says. On average, you’ll save a third on co-pays for brand-name drugs when you buy through the mail.

7. Use a preferred drugstore.

Almost three in 10 employers had a preferred network in 2015, meaning workers got a discount at certain drugstores, according to PBMI. Another 13% had a limited network, meaning insurance paid only for prescriptions filled at in-network chains. Medicare plans can also have preferred or limited networks. Preferred pharmacies generally offer good discounts, Frazee says: “The savings can be considerable, particularly if you’re on brand medications.”

Free to choose any pharmacy? Use the OneRx app to see which ones offer the lowest prices. Take a photo of your insurance card, and the app will show estimated co-pays based on your plan. The app also shows cash prices, the amount you would pay without insurance; these can sometimes be less than your co-pay, says A.J. Loiacono, chief innovation officer at Truveris, which created the app. Just remember that if you bypass your insurance, the payments won’t count toward your deductible or out-of-pocket maximum.

8. Beware of online pharmacy scams.

When looking at online drugstores, be cautious. Many of the “Canadian pharmacies” you’ll find on the Internet are fraudulent, according to a 2013 Government Accountability Office report—which also noted that some drugs ordered online contained “dangerous contaminants, such as toxic yellow highway paint, heavy metals, and rat poison.”

You can be sure a web pharmacy is safe if its domain name ends with “.pharmacy,” which means the site has been approved by the National Association of Boards of Pharmacy and meets all regulatory requirements. You can also search for the site’s name on to confirm that it’s aboveboard.


9. Check your insurer’s formulary lists.

To make the biggest dent in high drug costs, you may need to change your insurance. Employers usually let workers choose new health plans in the fall; Obamacare marketplaces are on a similar timetable. And seniors can choose new Medicare plans starting Oct. 15.

To compare plans, start by checking the formulary lists to ensure that medications you take are covered, Votava says. (These lists are often online, but in some cases you may need to request the document from a prospective insurer.) Identify which tiers your drugs are in, and then use each plan’s “summary of benefits and coverage” to see how much you would pay in each tier. “Get used to doing a little more homework,” Votava says.

Drug coverage is of particular concern for people on Obamacare plans, some of which have placed all the necessary drugs—even generics—for certain chronic conditions in the most expensive tier. A 2014 study by the Pharmaceutical Research and Manufacturers of America identified higher drug costs for Obamacare enrollees with cancer, diabetes, rheumatoid arthritis, and even asthma. And a New England Journal of Medicine study found that HIV patients on plans with such “adverse tiering” owed $3,000 more than HIV patients on other plans, even after accounting for out-of-pocket maximums and premiums.

Trying to calculate what you’d owe? Get help. “Call the pharmacy help desk for your plan,” Votava says. “They are going to be your best shot.” Tell the rep the plan you’re considering and the medication you’re on, she says, and ask what price you would pay.

10. Check for tricky deductibles.

For many patients, drug co-pays kick in from the first day of coverage. But last year, KFF found, almost a quarter of workers on high-deductible employer plans had to pay full price for prescription drugs until they met their overall deductible—more than $1,300 for individuals and over $2,600 for families. That could require a big outlay for people with high drug costs.

And 36% of employer plans in 2015 had a separate drug deductible, up sharply from 14% in 2014, according to PBMI. On average, drug deductibles are $325 for individuals and $960 for families. “You go to the drugstore more than you go to the doctor, so you’re more likely to feel it faster,” PBMI’s Frazee says.

At least one change has delivered a measure of relief. Under the Affordable Care Act, all new employer and marketplace plans must cap how much you’d pay for in-network care each year. In 2015 the average out-of-pocket max was $3,291 on individual PPO (preferred provider organization) plans, according to KFF. So if you face high drug costs, you may be able to save by choosing a plan with higher premiums but a lower cap. To gauge your potential liability, add a given plan’s premiums to the out-of-pocket max, Votava says.

11. Price out Medicare options.

Part D beneficiaries have a somewhat different set of rules and concerns. Unlike employer and marketplace plans, Medicare drug plans have no out-of-pocket maximums, so you can continue to hemorrhage cash if you’re taking expensive drugs.

Meanwhile, out-of-pocket costs can vary widely between plans, notes a KFF survey. For example, a drug called Spiriva, used to treat emphysema, costs a Medicare Part D beneficiary as much as $472 per month in 2016 on one plan—but as little as $33 on another. Diabetes treatment Lantus Solostar ranges from $29 to $172 a month; generic cholesterol drug atorvastatin costs $20 a month on one plan but is free on another.

You need to shop around every year; Fassieux says coverage lists change all the time. The Medicare Plan Finder at makes it easy to search plans, however. Enter your medication information, including dosage and frequency. You can also enter the name of your favorite pharmacy in case some of the plans have preferred or limited pharmacy networks. The tool will show you your expected costs on both Medicare Part D and Medicare Advantage prescription-drug plans.

Again, remember that what was cheapest last year won’t necessarily be the right answer this year, even if your drug regimen hasn’t changed.

“We see people who didn’t look at their plans; they didn’t do anything,” Fassieux says. “Then they go to the pharmacy, and their co-pay has tripled.” Don’t be among them.


If you take a high-price brand-name drug and have exhausted other ways to reduce your costs, you may need extra help. Two options:

12. Clip coupons.

Some drugmakers offer discounts directly to patients. If you take any brand medications, says health care consultant Martine Ehrenclou, check the manufacturer’s website for coupons. (Medicare beneficiaries are ineligible.)

13. Ask for help.

Pharmaceutical companies also have patient-assistance programs to aid people who have a hard time affording their treatment. There may be income limits and other requirements. Check,, and to find programs for your medications.

8 03, 2016

To Google or Not to Google? New Health/Medical Search Engine for Patients

By | March 8th, 2016|Current Health Topics|1 Comment

patientresearchWhat’s one of the first things you do if you or a loved one receives a diagnosis or treatment plan from a physician or other qualified medical provider?

If you’re like me, you look it up. Not just to sift through the information to make sure the doctor is right, but also to inform myself. The more I know, the more easily I can conduct educated conversations with physicians about my diagnosis or treatment plan. I do not want to leave everything up to any clinician, as passive patients do not experience the best outcomes in care.

Becoming informed about a proposed diagnosis or recommended treatment (if it makes sense), the more invested and committed I become to following through on my doctor’s advice.

Of course, it can very well work the other way too. If I doubt the diagnosis because something doesn’t add up, I do my research. For example, if I’m given a diagnosis, I research the symptoms and if a couple of the top five don’t apply, I do more research and then obtain a second opinion from a qualified specialist.

Where do most patients go for health/medical information? Mr. Google is fine if you can wade through information that isn’t credible to find the good stuff. That means that you’ll most likely come across inaccurate information and possibly scary stories that just aren’t based on fact or evidence.

How many patients do you know who are able to bypass the unreliable on Google to find trustworthy information? I bet you can count them on one hand. To be fair, I’ve hurled myself onto Google with my symptoms and scared myself half to death.

I try not to sound like I’m preaching when I encourage patients and families to research an illness, condition or treatment on medical academy or medical society websites, disease organizations, medical school websites, certain government websites, or certain online patient communities.

I came across a new health/medical search engine for patients called MedNexus. Actually, Nathanael Geman, co-founder and CEO of MedNexus contacted me. I rarely write about health/medical companies that reach out to me in hopes that I will spread the word about them. This one was different. I did a couple of test runs on the website and found that the site was easy to navigate and that credible information came up in a condensed, easy-to-read fashion.

Through MedNexus you can find the most “relevant content from a variety of courses such as medical journals, government health sites, patient forums and more.”

Check it out and see what you think. MedNexus is still a work in progress and they claim to be happy to receive your feedback.

In writing about MedNexus, I was not compensated in any way. Honestly, I think this site could be very helpful to patients and families.

3 03, 2016

Is There Something Fishy with the Xarelto Clinical Trial?

By | March 3rd, 2016|Current Health Topics|0 Comments

MedicationThe article in The New York Times, Document Claims Drug Makers Deceived a Top Medical Journal, is curious indeed. The question was asked—did two major pharmaceutical companies mislead editors at The New England Journal of Medicine by omitting data about the stroke-prevention drug Xarelto?

Patients and families are suing Johnson & Johnson and Bayer over the safety of the anti-clotting drug, Xarelto (rivaroxaban.) The lawsuit, filed by 5,000 patients and families, claims they were harmed by Xarelto. 500 of the 5,000 involved patient deaths.

Xarelto is a top competitor in stroke-prevention drugs. Warfarin is the older blood-thinning drug, considered the standard for treatment of atrial fibrillation.

Here’s where the interesting part begins. Johnson & Johnson and Bayer hired The Duke Clinical Research Institute to run a 3-year clinical trial that involved more than 14,000 patients. This trial led to the approval of Xarelto by the FDA.

The clinical trial compared bleeding events and the number of strokes experienced by patients taking Xarelto to the bleeding events in patients taking warfarin. Xarelto proved to be superior to warfarin, according to Duke Medicine News, Major Study Shows Ability of New Agent to Prevent Strokes in Patients with Atrial Fibrillation.

The accusation from patients is about a faulty blood testing device used in the study which may have led doctors to give them the wrong dose of warfarin, which in turn could have boosted Xarelto’s results over warfarin.

Duke researchers published an analysis in the NEJM and concluded that the device problems did not change the study’s results. Duke researchers also claimed that it conducted its research independently of Johnson & Johnson.

In light of the lawsuit by 5,000 patients and accusations that the data from the study was not accurate, and the fact that Johnson & Johnson and Duke researchers maintain that Xarelto is superior to warfarin, I decided to dig a little further to see if there was any connection between Johnson & Johnson and Duke University.

Indeed there is.

A. Eugene Washington is president of Duke University Health System and is also on the board of Johnson & Johnson. Washington left the position of dean of the David Geffen School of Medicine and CEO of the UCLA Health System in the midst of a conflict of interest scandal.

Guess what that conflict of interest scandal was about?

Dr. Eugene Washington was paid $260,000 last year by none other than Johnson & Johnson. Washington is their company director and is currently on their board of directors. See article, Duke University Hires New Medical leader from UCLA,  for further information on the scandal.

There is more.

Guess who is the newly appointed commissioner of the FDA, the very regulatory agency that approves drugs to be sold in the United States? Dr. Robert M. Califf, MD who is the past president and vice chancellor for clinical transitional research at Duke University. He also served as director of the Duke Translational Medicine Institute  and was founding director of the Duke Clinical Research Institute.

Duke Translational Medicine Institute: “Duke Translational Medicine Institute strives to overcome the obstacles to developing discoveries into devices, drugs, or therapies to improve health. Sometimes those obstacles are financial – finding funds to pay for proof-of-concept testing.” See link here.

Duke Clinical Research Institute: “As part of the Duke University School of Medicine, the Duke Clinical Research Institute is known for conducting groundbreaking multinational clinical trials, managing major national patient registries, and performing landmark outcomes research. The DCRI also is home to the Duke Databank for Cardiovascular Diseases, the largest and oldest institutional cardiovascular database in the world, which continues to inform clinical decision-making 40 years after its founding.” See link here .

There’s more to this story, I’m sure of it.

What do you think? Is there a conflict of interest in any of this? Do you see some connections that could be questionable? Who might be benefiting from the approval of Xarelto besides the pharmaceutical companies?

I welcome your comments.

16 02, 2016

The Take-Charge Patient’s Toolkit: free download

By | February 16th, 2016|Current Health Topics|0 Comments

Take-Charge Patient high-resWhether you are dealing with a new medical problem, an ongoing condition, or a serious illness, having a roadmap to guide you through the healthcare maze is invaluable.

The Patient’s Toolkit was developed to help you actively participate in care and engage with your doctors and nurses with more confidence. You can download the toolkit here. It is free.

The Patient’s Toolkit includes several forms, checklists and sample questions to guide you through key points in your medical care. It is a companion piece to my award-winning book, The Take-Charge Patient.

Your medical care is a team effort and you are a very important part of the process. To increase the quality and safety of your care, these easy-to-use aids allow you to maximize the time with your medical providers and assist you to become more informed.

Many patients and their advocate families do not know how to navigate our healthcare system, how to ask questions or which questions to ask, how to track symptoms to support a physician’s efforts to arrive at an accurate diagnosis, make the most of precious minutes with a doctor, and prevent medical errors.

The Patient’s Toolkit is your personal guide. It includes a medical ID card that you can fill out and slip into your wallet so you have it with you at all times so you don’t have to depend on your smart phone or other electronic device. You can download the Patient’s Toolkit here. If you are actively involved in your care and become informed about your diagnosis and treatment plan, you will experience increased safety and better quality care.

Ask questions if you do not understand something your doctor or nurse explains to you. Medical information can be complex and it’s foreign to most. Use The Patient’s Toolkit to document information about your diagnosis, treatment, next steps and when to follow up with your medical provider. Being prepared will increase your self-confidence and maximize the time you have with your medical provider.

I look forward to hearing from you about your success with your new Patient’s Toolkit. Your suggestions are welcomed.


For for information on The Take-Charge Patient: How You Can Get the Best Medical Care, please visit

7 01, 2016

Patients Need Patient Advocates

By | January 7th, 2016|Current Health Topics|2 Comments

Doktor und Patient Handeschütteln

I just got off the phone with a good friend who’s been struggling with some medical issues. I heard the defeat in her voice right away when I asked how she’d been doing.

Susan mentioned that she’d seen her gastroenterologist the previous week. “Dr. Snark was irritated with me.”

I’d heard this before about Dr. Snark and not just from Susan. But now she was more vulnerable, less able to shake it off. She’d had gastrointestinal problems for the last year and hadn’t been feeling well. Plus, she’d been given some potentially frightening news about plaque in her arteries. In her mid seventies and a widow, she didn’t need a doctor to disrespect her.

The phone to my ear, I said, “What do you mean he was irritated? What happened?”

“I was describing my symptoms and he cut me off and told me to stick to the point. And not in a nice way either. He was obviously very irritated.”

“That’s not okay,” I said, picturing Dr. Snark, the head of gastroenterology at a teaching hospital, treating Susan like that. I’d encountered his unpleasant manner myself once.

Susan continued. “He also said I had so many things wrong with me, so many medical issues to deal with.” She sighed. “It just made me feel bad.”

“Must have made you feel kind of like giving up,” I said. “If your own doctor can’t handle your medical issues, who can?”

“Yes, exactly,” she said, waking up. Just being validated made her feel like less of a source of dissatisfaction to her doctor. “That’s exactly how I felt. I came home and I guess I’ve been here ever since.”

Some doctors just don’t realize the effect they have on patients. You can make all the excuses you want about them being pressed for time, how healthcare hasn’t been kind to most doctors in the last few years, how non-compliant patients feed their frustration, and more. But there’s no excuse for a patient leaving a doctor’s office with her hope in the palm of her hands.

Recently, Susan had been told that plaque in her arteries was causing her leg pain. Susan is astute enough to know that blockages can cause heart attacks and strokes. She’d begun a fairly rigorous walking regime, which her internist advised her to do in effort to avert major surgery. According to Susan, her internist had said that walking might help to get the blood moving in her legs.

But that news had caused her to feel more vulnerable, old. She didn’t need a gastroenterologist to make her feel worse.

“Did you say anything to Dr. Snark? “

Feeling protective of my friend, I wanted to hear that she told him to F*off. Part of my anger, I’m sure, was due to having been in a similar position with a couple of arrogant doctors four years ago. I’d had severe, chronic, lower abdominal pain for 16 months and saw 11 physicians in effort to get an accurate diagnosis and treatment plan.

Most of the physicians I saw tried their best and sincerely wanted to help me. But two doctors didn’t and wrote me off as a difficult patient. 10 misdiagnoses later, I found my own diagnosis in a New York Times article and the surgeon and hernia specialist to heal me. She did the appropriate tests, performed three-hour surgery to repair the muscle tear at my C-section site that had nerves pinched in the holes and an inguinal hernia with nerve involvement as well. Thanks to her, I’ve been pain free for over four years. And I don’t take being pain free lightly after what I went through. I am immensely grateful to her.

Susan exhaled and I could envision her shoulders falling forward. “No, I kept quiet.”

“I hope you never go back to him,” I said, probably a little more forcefully than I should. “You shouldn’t be treated that way. Besides,” I added, “You know how he over-tests to make more money.”

Susan managed a weak laugh. “He wants me to have an endoscopy every year.”

“Is that because of the pre-cancerous condition in your throat? Something connected to GERD?” I’d asked her before for the name of the diagnosis but never heard it in a clear way.

Susan tried to wave me off. “Oh, I don’t know. Something that could turn cancerous.”

I jumped in with both feet. “I think you need a second opinion on the diagnosis Dr. Snark gave you about your throat and the pre-cancerous condition. Besides, a good relationship between you and your doctor is essential for good care. You have to feel comfortable with your doctor and you don’t with Snark.”

“True,” Susan said. “My internist recommended that I ask Dr. Snark for a breath test because of the ongoing diarrhea, nausea and bloating.” She paused. “You know how long I’ve been dealing with this.”

“Yes, longer than I did.” My gastroenterologist ordered several tests and a breath test. I tested positive for bacterial overgrowth and after the medication, I feel better than I have in a long time.

“Dr. Snark refused to give me a breath test.”

“What? Why?”

“He said I had one in 2009 and it was negative.”

“But it’s 2016.” I was winding up, anger fueling my words. “Did you explain to him that your internist recommended a breath test?”

“Yes, I told him. He wants to do another endoscopy.”

I exhaled sharply. I wondered if Dr. Snark denied the breath test because he makes less money since that test is done at the hospital and the endoscopy is done in the surgery center that he owns. I kept my thoughts to myself.

Her voice wavering, Susan said, “I don’t want another endoscopy right now. Something about it just doesn’t feel right. Seems like I just had one.”

“Listen,” I said as adrenalin lit my brain. “Here’s the name and phone number of my gastroenterologist. At least see him for your current symptoms and get a second opinion on your throat thing.” As we spoke, I emailed her his contact information and link to his website.

And then something occurred to me. “Who gave you the diagnosis of the blockage in your legs?” Once again I wished that Susan would share the exact diagnoses given by her doctors. Maybe she was afraid that I would research them and find out they were worse than she’d thought.

“My internist.”

“Did you recently get imaging tests done?”

“No, only the full body scan from two or three years ago that the cardiologist ordered.”

“Did your internist have the imaging tests there with her when you saw her?”

“No, just the report from the cardiologist.”

I asked, “Did that report specifically say you had blockage in the arteries in your legs? I don’t remember you mentioning that when you had that full body scan. But it’s been a while.“

Susan was silent on the other end. “I don’t know.”

Did she have the right diagnosis? At least 5 percent of outpatients experience diagnostic errors, and I suspect that percentage is very low.  I suggested that Susan go back to the cardiologist for the pain in her legs. I repeated the importance of seeing a new gastroenterologist for her current gastrointestinal symptoms and for a second opinion on the throat/GERD issue.

Susan perked up. “You know, as we’re talking I’m beginning to see things a little more clearly. I haven’t been feeling well and I just am not on top of things. I just took what Dr. Snark said to heart and that was it.”

“It happens to everyone,” I said. “Especially if you aren’t feeling well. Let me help you get your records and information together so you’ll be prepared when you see the next two doctors.”

Susan thanked me and said she felt much better. Patients most always feel better when they take some control over their healthcare and become a part of the equation, part of the discussion and decision-making. I emailed her a to-do list and offered to help her create her own packet of health information with symptom diary, medication list, allergies to medications, list of questions for doctors, copies of pertinent medical records, and more.

I wonder how patients with multiple medical conditions or complex cases make it through our fragmented healthcare system alone. Especially if they aren’t feeling well. How does anyone advocate for themselves successfully without becoming overwhelmed or confused?

We all need patient advocates to assist with our doctor visits and hospital stays. We need them to help sift through the quagmire of fragmented care, the lack of communication between doctors, to encourage second opinions, to research diagnoses, medications, treatments and tests. To help us remember what we might have forgotten when clinicians convey complex medical information.

Advocates should be provided and paid for by health insurance. It would certainly help patients and could very well help the bottom line of health insurance companies.

With preventable medical errors taking the lives of 400,000 people a year, and costing our country one trillion dollars annually, don’t you think we need to change something with our system?

Not every patient is able to be an effective self-advocate. Not every patient has someone to help them. Not every patient can or is willing to deal with online patient portals, Health IT, apps, and more. Sometimes it just comes down to the need for a caring human being to help.

2 11, 2015

The Toyota Effect: Improving Healthcare Delivery

By | November 2nd, 2015|Current Health Topics|0 Comments

UnknownWhen you think of Toyota auto manufacturing, you might not think of healthcare. But in the new short film series, The Toyota Effect, one of these short films does. And the results are impressive.

The first film, Saving Sight, by academy award-nominee Keif Davidson, features the intervention of the Toyota Production System (TPS) with the struggling Harbor-UCLA Medical Center’s eye clinic, which treats the underserved patient community in Southern California. In a moving story, a patient, Liseth, is featured. She is nearly blind and in need of immediate eye surgery. However, she is on a wait list for  surgery along with hundreds of other patients who are forced to wait months for treatment. Many go blind in the process.

Harbor-UCLA Medical Center reached out to Toyota for help. They didn’t know what was wrong with their operations but understood that working in chaos had stretched their hospital staff beyond capacity.

With the help of Toyota, Harbor-UCLA was able to streamline the efficiency of their operating system and enlist the support of hospital employees as problem solvers. With simple steps such as color-coding their system, they are now treating patients with urgent needs more quickly. Liseth had her eye surgery and has recovered her sight. The hospital’s wait list has now been eliminated.

The second film of The Toyota Effect, entitled 116 Innovators by award-winning director Steve James, is about the Chicago company, ACE Metal Crafts, a U.S. steel manufacturing company that grew so quickly that its capacity was completely outpaced by growth. The CEO of the company, Jean Pitzo, reached out to Toyota for help. With the assistance of TPS, chaos was quickly replaced by employees working in collaboration. Production time was shortened by several weeks. ACE Metal Crafts was able to satisfy more customers and become more competative in the marketplace.

In the film, Pitzo explained that TPS taught her that the leaders of a company disrespect their employees when the system isn’t flowing efficiently. In partnership with TPS, Pitzo and her staff streamlined the operations, thereby increasing employee satisfaction and motivation.

Imagine if Toyota Production System were to partner with our major hospitals in the U.S. to streamline their operations and to help their doctors and nurses feel more valued and respected.

Initially, clinicians and hospital administrators might be apprehensive about TPS intervening. They might be hesitant to welcome a large company to come in and identify problems and offer solutions. But if you consider the 210,000-440,000 people who die from preventable medical errors every year, maybe it’s time they consider some outside help.

Staff from TPS reports a commitment to zero job loss for employees of organizations they work with. They claim to focus on people, on supporting them in their jobs. As a result, employees experience increased personal investment in their work.

According to a 2011 American Nurses Association survey, three out of four nurses reported feeling stressed and burned out. The ANA attributed problems of fatigue and burnout to a chronic nursing shortage.

46 percent of physicians reported feeling burnout, according to a Medscape Physician Lifestyle report.

Imagine if TPS were to work with hospitals with the highest rates of burnout among their clinicians and employ their successful strategies. Isn’t it possible that we’d have fewer preventable medical errors? If employees were trained to work together in teams, to collaborate with one another, and even to contribute ideas to solve problems, isn’t it possible that quality of care and patient safety would be greatly improved?

According to the World Health Organization, effective teamwork in healthcare can have an immediate and positive impact on patient safety.

Because TPS is a process-oriented approach, it can be applied to any hospital or healthcare organization. This approach involves taking an objective view of the internal process of an organization, analyzing workflow, and implementing small steps to fix deep, underlying problems.

Preventable medical errors are tragic examples of our dysfunctional healthcare system. The U.S. healthcare system is rated 37th in the world, and that’s behind Costa Rica and Slovenia. Healthcare spending hit 3.1 trillion in 2014. According to the CommonWealth Fund, U.S. healthcare is the most expensive in the world and yet underperforms relative to other countries on most dimensions of performance.

Maybe it’s time we look to Toyota Production System and ask for help with developing a “lean” healthcare system in the U.S.

To view The Toyota Effect short films see here.

I welcome your comments.

7 10, 2015

Diagnostic Errors: new IOM report emphasizes patients’ collaboration with doctors

By | October 7th, 2015|Current Health Topics|0 Comments

If you weren’t aware of the prevalence and severity of diagnostic errors, (misdiagnosis, missed diagnosis, delayed diagnosis) you might be now.

The Institute of Medicine (IOM ) released a new report called, Improving Diagnosis in Health Care. The report cited that most people will experience one or more diagnostic errors over their lifetimes. It also revealed that diagnostic errors contribute to 10 percent of patient deaths and account for up to 17 percent of hospital adverse events. But because of a scarcity of reporting and research on diagnostic errors, those numbers might be very conservative.

According to Mark Graber, MD, president of The Society to Improve Diagnosis in Medicine, diagnosis is wrong 10-15 percent of the time.

It happened to me. 10 times to be exact. During a 16-month long, severe chronic pain condition, I received 10 misdiagnoses from 11 physicians with different specializations. Along with the 10 misdiagnoses came 15 procedures and tests. Luckily, I found my own diagnosis in a New York Times article, In Women, Hernias May Be Hidden Agony

The surgeon and hernia specialist featured in the article, Shirin Towfigh, MD, diagnosed me correctly. She performed 3-hour surgery to repair a muscle tear in my C-section site and an inguinal hernia with a nerve pinched in the hole. I’ve been pain free for over 4 years and I am very grateful to her.

Some aren’t so lucky. Take Rory Staunton who was misdiagnosed in the ER with an upset stomach and dehydration. He died from severe septic shock brought on by a bacterial infection. There are countless others whose cancer or heart attacks were completely missed or misdiagnosed as innocuous ailments.

Arriving at a diagnosis can be an allusive process, not always easily uncovered through physical exams or tests. What contributes to misdiagnoses or missed diagnoses? See the Society to Improve Diagnosis website for causes.

The IOM report produced a number of recommendations for clinicians and insurers to improve diagnosis. It also emphasized patient and family collaboration with doctors. Since patients and their loved ones are such an important part of the diagnostic process, it’s essential that you know what you can do to help improve your chances of receiving an accurate diagnosis.

Here is where you come in.

As a patient, you are in partnership with your doctor. To be an effective team player you need to be an active participant in your care, not simply a passive recipient. If you aren’t feeling well enough to be proactive and form a mutual collaboration with your doctor, ask a loved one to assist. For more information on how to do this, please see my book, The Take-Charge Patient.

Free Patient’s Toolkit see here You do not have to input any personal information for the free download.

Tips to Help Ensure an Accurate Diagnosis

Symptom Diary

  • Before you see your doctor, create a symptom diary. Document your symptoms in a notebook, on your smart phone or other electronic device. Answer these questions:
  • What are your symptoms?
  • Where are they located?
  • What makes your symptoms worse or better, such as exercise or eating a meal?
  • Time of day your symptoms are better or worse?
  • What you have tried to alleviate your symptoms? Did they help or not?
  • If pain accompanies your symptoms or pain is the symptom, track it. On a scale of 1-10, 10 being the worst, document it every day.
  • Bring your symptom diary with you to see your doctor and enter into a dialogue with him/her.

List of Questions Before You See Your Doctor

Create a list of questions before you see your doctor. This allows you to think about what you need to focus on. Document the answers and pieces of the conversation you believe are important.

You Are Given a New Diagnosis

If you are given a new diagnosis from your doctor, consider asking these questions:

  • What is my diagnosis and what does it mean?
  • Are there any other possible diagnoses for my symptoms?
  • How did you arrive at this diagnosis? I.e.: test results, physical exam, radiology report, etc.
  • What is my treatment plan?
  • When do I follow up with you about my treatment plan?

If You Suspect a Misdiagnosis

If your treatment is not helping your symptoms, discuss it with your doctor. It’s possible that there is an alternative treatment that might work better for you.

  • Ask your doctor if it’s possible that you might have a different diagnosis.
  • Work with your doctor.

Ask That Tests Be Repeated or Read by a Different Clinician

Tests can be wrong or they can be read incorrectly. Ask that tests be done a second time or read by another doctor. Many doctors read reports given to them by radiologists regarding any imaging studies you’ve had. Ask that your doctor or another doctor read those tests.

Get Copies of your Medical Records

Obtain copies of your pertinent tests such as MRI, CT scan, X-ray, blood test results, surgery/op report. You should have all of these anyway in a health file at home, but if you don’t, simply make the request. You might have to sign a form or pay a small fee. Bring your own copies of tests to each new doctor you see.

Get a A Second Opinion

Patients are sometimes afraid to get second opinions. Please don’t be. It is your right and should not offend any medical professional.

  • Ask a doctor you respect and have confidence in to recommend a specialist.
  • Ask an RN or other healthcare professional for a recommendation.
  • Ask/email your loved ones, colleagues and any physicians you know for a respected physician to see for a second opinion. You will see some of the same names recommended.

Every Time You See a New Doctor

Bring all the items listed above with you to each and every medical appointment with a new doctor. Take notes while you’re there.

Bring a Loved One with You

It’s not easy for anyone to hear, much less remember correctly, what a doctor says. Especially if you aren’t feeling well. Bring a loved one with you to each appointment with a doctor. Ask that person to take notes. You can review the information with that person at a later time.

Research a Diagnosis

If you are informed about your diagnosis, you will be better prepared to ask questions. To research a diagnosis go to credible websites such as:

  • medical school websites.
  • medical society or academy websites.
  • disease organization websites.
  • government websites.

Googling symptoms and diagnoses can easily lead you to inaccurate information and scary stories.

My Patient’s Toolkit is here. Free download. You don’t have to input your email address or contact information. It is free to you to use at your leisure.

For more information, please visit


7 10, 2015

Patients Secretly Record Visits With Their Doctors

By | October 7th, 2015|Current Health Topics|0 Comments

Recently, I accompanied my husband to an office visit with his orthopedic surgeon. Jamie had been experiencing set backs in his recovery from major surgery. I went with him because it can be pretty hard to distill medical information on the spot, much less remember it. I wanted to document what the surgeon said so I could research it later. The more information Jamie had, the more of an informed choice he could make about his treatment options. My husband was in pain, something that interferes with recall even in the best of situations. I hoped that if I were with him, it might also help him feel more at ease.

Since I suspected this office visit might contain some complicated and possibly stressful information, I considered recording what the surgeon said by using an app on my iPhone. I envisioned asking the doctor’s permission to record the conversation and decided against it because he might not have responded well to that idea. Some physicians and other providers react with suspicion and a defensive medicine posture when asked by patients to record what they’ve said.

My husband’s surgeon had a reputation for highly successful surgeries but not the greatest bedside manner. He’d always been pleasant with us, but since my husband’s recovery had been compromised with episodes of pain, I decided that an audio device could have instigated alarm. That would have interfered with the doctor’s focus on Jamie. With only 7-10 minutes, we had to make the most of this office visit. I wanted my husband out of pain.

In place of an audio recording, I took notes instead.

Healthcare professionals are well aware that patients experience anxiety in their exam rooms. It’s called white coat syndrome or white coat hypertension. Anxiety interferes with cognitive function, especially memory, making it difficult not only to process medical information, but to remember it. Besides, medical information can be complex. It’s hard to understand, especially in a foreign and uncomfortable medical environment such as a doctor’s office.

40-80 percent of medical information conveyed by healthcare practitioners is forgotten immediately by patients. Half of information retained by patients is incorrect. That’s such a small percentage that you’d think doctors would be handing out their own recordings to patients for every office or hospital visit. It might actually help with discharge planning from hospitals.

In theory, it should be perfectly acceptable for patients to record conversations with their medical providers. It’s a known fact that physicians are plagued by lack of follow through with treatment advice. What might be interfering with treatment adherence for patients is overwhelm or information overload. Others might be challenged with hearing impairment or low health literacy levels.

How many times have you visited a doctor and left the office only to forget some of what the doctor explained and told you to do next? I know I have.

But recording brings up fear of medical malpractice lawsuits for some physicians, even if permission is requested ahead of time. According to American Medical News, recording of the visit between doctor and patient could “exacerbate physicians’ temptation to practice defensive medicine.”

It’s hard for me to imagine that patients wouldn’t ask permission to record what their doctors tell them. But according to the KPCC article, When is it OK to record your doctor’s orders? patients are in fact secretly recording conversations with their doctors without asking permission first.

Talk about a blow to the patient-provider relationship.

Why not just ask a physician or other provider if it’s okay to record the conversation? All you have to do is explain that it’s hard to digest medical information as well as remember treatment instructions and you want to refer to the information so you get it right. Why record in secret?

To secretly record an office visit is a violation of trust. In California, the law specifies that both parties have to be aware that a recording is in place. Doctors are already afraid of being sued. Why would any patient surreptitiously tamper with the relationship with his/her doctor, something that is considered the cornerstone of quality care? Just ask the question. If permission to record is denied, you can either take notes or find another doctor.

In my most recent book, The Take-Charge Patient, I emphasize the importance of documenting the information your doctor gives you because it’s just too easy to misunderstand, forget, or walk out of the office without all your questions answered. It’s helpful if a doctor or other provider has a patient portal with access to notes and records, but that doesn’t take the place of your own documentation.

Tips to Remember What the Doctor Tells You

  • Prepare questions for your doctor ahead of time. This allows you to think about what you want out of the office visit.
  • Document the answers in a notebook, on your smart phone or other device. You will be able to reference instructions and explanations later when you are in a more relaxed environment.
  • Bring a loved one with you to take notes for you.
  • Some physicians and other providers offer a summary of your office visit. Ask if your provider offers this. But in addition, take your own notes.
  • Ask for a copy of tests performed by the doctor or imaging center at the time of service.


There are many more tips for patients’ visits with medical providers. I offer a free and no obligation Patient Toolkit on my website


29 07, 2015

Rapid Increase of Cyber Attacks on Patients’ Medical Records: 8 tips to protect your data

By | July 29th, 2015|Current Health Topics|0 Comments

Your personal health information in your medical records might be scattered across a few doctor’s offices, a clinic or two, or even a hospital. Your health insurer certainly stores some important personal information about you. If you’re like me, you’ve changed health insurers a couple of times since the advent of the Affordable Care Act. This means that more than one health insurance company has your social security number, home address, phone number, email address, name of employer, list of diagnoses and possible medications. Just enough for a cyber criminal to snap it up in a few seconds and then monetize and sell your private information on the black market.

I don’t hear many talking about this. Few seem to be concerned even though major news media have been sounding the alarm for a couple of years.

Maybe it’s time to listen up.

There has been a sharp increase in cyber attacks and security breaches in healthcare organizations, exposing millions of patients and their medical records. According to a new Ponemon Institute study in May of 2015  criminal attacks on hospitals, clinics, healthcare providers and health insurers are up 125 percent since 2010. The study also revealed that most healthcare organizations are still unprepared to protect patient data. Nearly 90 percent of healthcare providers were breached in the last two years.

Why would cyber hackers want information in your medical records?

Cyber criminals are after your medical records because your personal information is all in one place and unlike credit card numbers, cannot be easily changed. Poached from your medical records are social security numbers, birthdates, medical IDs, addresses, and personal health information. This is a gold mine for criminals who retrieve your information and use it for their benefit, and at your risk.

I’m sure you’ve heard about the recent cyber breach at UCLA Health Systems. Hackers broke into the network and may have accessed personal patient information from 4.5 million patients’ medical records. 

My physician’s practice was bought by UCLA a while back, so this could directly affect me. Maybe you too.

This comes on the heels of the major cyber breach into Anthem, Inc., which affected 80 million Americans.  Anthem is the 2nd largest health insurer in the U.S.

Last year alone, health records on 88.4 million people were breached as a result of theft or hacking. Data that was exposed were names, birthdays, medical IDs, social security numbers, street addresses, email addresses, employment information and income data.

UCLA and Anthem are only two of the major organizations whose networks were hacked for all kinds of valuable information for cyber criminals to sell on the black market. The list includes Premera Blue Cross, Community Health Systems, The U.S. Postal Service, The U.S. Government Office of Personal Management, Sony, Staples, Kmart, Home Depot, JP Morgan, and many more.

With the onset of electronic medical records (EMR), healthcare organizations are particularly vulnerable. Their security is often less sophisticated than other organizations.

Reuters reported, “Your medical information is worth 10 times more than your credit card number on the black market.” 

Fraudsters use your personal data from medical records to create fake IDs, take out loans, open up lines of credit, and buy medical equipment or drugs that can be resold. They can also combine patient numbers with false medical provider numbers and file false claims with health insurers.

These criminals can also impersonate you to obtain health services.

After the Blue Cross cyber security breach, one patient discovered that his medical records were compromised after he started receiving bills for a heart procedure he never had. In addition, his personal info from his medical records was used to buy expensive medical equipment which incurred thousands of dollars in fraud.

“All healthcare organizations, regardless of size, are at risk for data breach,” revealed the Ponemon Institute study.

It’s time to wake up.

Unlike stolen credit cards, which can be easily detected and cancelled, if your personal medical information is stolen from your medical records, it might not be detected for years. Your medical records could be compromised with diagnoses that don’t belong to you, wrong blood types, and other errors. This could be serious if you have an urgent medical situation.

Note: If you are a caregiver for a patient, it is very important to be vigilant for him/her too, especially if the patient is elderly. 

Tips to Protect Yourself (or a patient you care for)

1. Ask your doctor or hospital about the security of their electronic medical records.

2. Request copies of your medical records and review them for errors.

3. Review your Explanation of Benefits (EOBs) that you receive by mail or have access to on your health plan’s website. Check for errors.

4. If you notice any errors, alert your healthcare provider or health insurer immediately.

5. Each time a medical provider requests your social security number, ask if the last four digits will suffice.

6. If you store copies of your medical records online be sure it has a secure platform.

7. Keep an eye on your credit report. Unpaid medical bills can be reflected in your credit rating.

8. If you have been informed that your healthcare provider or insurer has suffered a security breach:

-Change all your passwords.

-Contact a major credit reporting agency and request that a fraud alert be placed on your account.

-If you received a letter about a security breach that could affect you, accept the free offer for credit monitoring, if applicable.

For further information, see my article published on KevinMD, How Much Health Care Data is Mined Without Your Knowledge?  

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1 07, 2015

Patient as Data Hub: get copies of your medical records

By | July 1st, 2015|Current Health Topics|4 Comments

For years I’ve encouraged patients to obtain copies of their medical records at the time of service. Whether an MRI, CT scan, lab results, reports from surgeries, procedures and more, it is essential that patients have their own copies so they can personally hand over what is needed for meetings with specialists, second opinions, or new consultations with medical providers. No one wants to have waited a month for a second opinion with a busy specialist only to find out during the appointment that requested medical records never arrived from a previous doctor’s office, hospital, imaging center or facility. It happens all the time.

In my latest book, The Take-Charge Patient: How You Can Get The Best Medical Care, I devote an entire chapter to the importance of gathering copies of pertinent medical records and placing them in a health file at home. You never know when you’ll need that MRI and if you do, timing might be crucial and you might not have time to wait.

It’s all about independence as a patient and taking charge of what you can.

Take Cheryl, a Medicare patient in an extremely busy internist’s office. She is scheduled for necessary surgery and has the required pre-op exam. Checking out at the office front desk, she requests that her pre-op exam report be sent to her surgeon’s office ASAP as her surgery is scheduled for the following week. “No problem,” the front desk person says.

Four days before her surgery, Cheryl receives a phone call from the surgeon’s office. She is informed that they still have not received a copy of the pre-op exam and that she cannot have the surgery without it. Cheryl calls her internist’s office, and again speaks to the front desk person who insists that her record was already sent to the surgeon’s office. Cheryl tells her that Dr. X hasn’t received it and asks if it could be sent again.

Another day goes by and still Dr. X’s office has not received a copy of her pre-op exam report. Out of frustration and a sense of urgency, Cheryl arrives at her internist’s office and requests a copy of her medical record for herself so she can send it to Dr. X’s office. Her surgery is important and the wait time for it would have been six weeks had it not been for a cancellation. Cheryl has to pay a small fee but leaves the office with a copy of her medical record in hand.

This could have so easily been prevented.

Ask for a copy of your medical record at the time of service. I’ve done it myself several times. For example, I had an MRI of my foot at an imaging center. I asked for a copy of it on CD and after waiting only 15 minutes, I received a copy for free (I cannot guarantee it will be free.) I have it in my health file at home just in case I ever need that MRI for a future medical consultation.

Finally, the media is picking up on the importance of this issue, not just for the sake of patients being in charge of themselves, but to increase patient safety. See WSJ article, How to Take Charge of Your Medical Records

I can almost guarantee there are errors in your medical records. You’ll want the chance to correct those so that misdiagnoses or other medical mistakes don’t follow you from provider to provider, often without your knowledge. It’s a mistake to rely on your medical provider’s electronic medical records for this reason alone.

In case you’re wondering if you are entitled to copies of your medical records, see this You have a legal right to copies of your medical records. In California the requirement is within 15 days.

You can scan your records onto a flash drive or some other means of storage that is portable. If you choose an online cloud-based storage platform via apps or websites, you run the risk of your records being hacked or mined for data without your permission. If you choose to go this route, be mindful of selecting a very secure cloud-storage platform, if secure is even possible right now.

Personally, I choose to house copies of my medical records without any connection to the internet. It might sound old school but it’s the safest way until internet security can be absolutely guaranteed.


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20 05, 2015

What is going on with hand hygiene compliance and healthcare-associated infections?

By | May 20th, 2015|Real Stories|6 Comments

Real Stories from the Streets of Healthcare!

 Martine Ehrenclou, MA, and Beth Boynton, RN, MS

With patients and healthcare professionals all too often on opposite sides of the table, our goal is to bridge that gap. As a patient/patient advocate and registered nurse, Real Stories From the Streets of Healthcare is our way of discussing real stories and issues that involve patients and families, nurses, other healthcare professionals, and the healthcare environment itself.  We plan to look behind the closed door, break down walls of silence, and tackle thorny issues to increase understanding of the complex healthcare problems we all face.  See our welcome page for  more information about our blog duets here.

Blog Duet # 3:  What is going on with hand hygiene compliance and healthcare-associated infections?


Hand hygiene seems like a simple thing.  It is well documented that following protocols decreases the incidence of healthcare-associated infections (which can be debilitating or life-threatening) and the spread of bacteria that are resistant to antibiotics. In preparing for this duet I did a little research looking for the latest statistics and recommendations about hand hygiene.  There is a lot available online and much of it requires sifting through sophisticated scientific data.  The CDC progress report  indicates significan reductions in many infections with an increase in catheter associated urinary tract infections. There’s even a ~200 page document by the Joint Commission called, “Measuring Hand Hygiene Adherence:  Overcoming the Challenges”!   I even found conflicting or at least confusing  information on CDC recommendations re: alcohol-based handrub versus soap and water handscrub.

Now, I’m not against science or data, please know this.  But as a busy nurse I only want to know what I need to know and I want the infection control people to distill out the essential information and make it available.  In my opinion, we have what we need to know:

  • Research supports association between nurse staffing and healthcare associated infections (HAIs).

  • Hand Hygiene in hospitals is less than 50 %  (OUCH!)

Let’s make sure there is enough staff (try putting a catheter in an obese patient without help or when you are rushing) and focus on behavior and the underlying communication and interpersonal skills that contribute to positive relationships and cultures.  Ironically, even solving the staffing dilemma requires effective communication that ensures nurses (and others) are able to set limits, delegate, and exchange constructive feedback as an ongoing dynamic that is going on all the time.   This is the kind of work that will ensure practitioners remind each other to wash hands and create the psychological safety that will help patients feel comfortable doing the same.


When I first read your post, I started doing some research with your thoughts in mind. I found studies and articles that support what you wrote. A Medscape article gave this example: a nurse is taking care of a sick patient in the NICU and the baby has an infection. Another emergency arises with another baby and the nurse has to rush to care for that baby and in the process doesn’t have time to wash her/his hands or because of the demands of the emergency.

I also understand about understaffing and time pressures. Ever since I interviewed over a couple hundred nurses for my books, I gained a lot of empathy for nurses and their struggles.  I heard first-hand what they are up against. Which is why in both of my books I tried to instill empathy for nurses and appreciation for the jobs they do. Patients need loved ones to act as their advocates when hospitalized because of the patient safety risks. It’s unfortunate that we have to enlist loved ones in the first place. Some nurses and physicians I interviewed said, “Never be a patient in the hospital alone. Always have a family member with you.” Hospital administrations need to do something.

But I keep bumping up against the commitment to the patient. The safety of the patient is the most important right? People are terrified of hospitals and for good reason. I’ve written about hand washing quite a bit because of the 1.7 million hospital-acquired infections a year in hospitals and the 99,000 people who die from those infections annually. Hand washing is such a simple act to prevent the spread of infections and it is the most effective. Washing one’s hands for 20 seconds in warm, soapy water does the job.

If we undergo a major surgery or life threatening event, we are treated in hospitals by clinicians who are supposed to help not harm us. The number of preventable HAIs and resulting patient deaths is just unacceptable. Those kind of odds would not work in any other business. But in healthcare it’s tolerated. Patients go to hospitals anyway because we have to. And if loved ones are available, we enlist them to act as our advocates during our hospital stays to help prevent HAIs, to prevent medication mistakes and other medical errors. We have no choice but to count on nurses and physicians to help us recover and heal. If patients truly are the #1 priority in hospitals, then something needs to be done to reduce the number of HAIs and deaths because of them.

As patients we are the customers. Through our health insurance, we pay the bills. In what other service industry would this kind of hazard be tolerated regardless of the internal pressures employees suffer with? Not to minimize what you describe as those pressures  are real, reported in studies, and they affect the morale of clinicians and then translate to patient care. But the argument that hand washing simply takes too much time (patient emergencies aside) is like saying we are too tired and stressed from a bad marriage to take care of our kids properly.


I hear you, Martine.  I really do.  And as a consumer or patient I agree that washing hands is a simple procedure that makes a big difference and should be done.  I know HAIs are a big problem and am a strong proponent of the work you are doing to encourage patients to remind healthcare professionals to wash hands and have an advocate with them as much as possible.   Staying as healthy as possible and avoiding hospitals is also wise, although I understand most people who are in the hospital are there because they have to be.

As a nurse, I want to scream, “Give me the resources and I’ll provide safer care.  Make sure that soap, towels, gloves, and alcohol-based sanititizers are easily and consistently accessible, make sure I have enough help to do ALL of the tasks I have to do according to the protocols of my organization, and create products that protect my skin.”  Proper handwashing, rinsing, and drying takes  closer to 1 min (the washing part is 20 sec).  I only pick at this issue because in a chronically understaffed hospital, I guarantee that if I do it right for one patient, I will have to cut corners someplace else.  (In the CDC slide-show they note 56 min out of an 8 hour shift for one nurse based on 1 min/wash and 7 times/hour [I’m sure it is more in some situation e.g. long-term care] ).  I can’t tell you how many times I had to go get paper towel or soap or that someone had hung a cloth towel on the back of the bathroom door in my last job.  It didn’t matter that I practically begged for more nurse assistant staff.  I also guarantee that if I have to go looking for soap or towels that this 1 minute can easily become 5 or more.  This is eternally frustrating in an environment that relentlessly calling upon us to do more than humanly possible.

A friend of mine told me once that she would want a nurse to be a martyr because she felt that nurse would turn over every stone to help her spouse.  She challenged me to consider the same if it were my son in the hospital.  As a mother, yes I want every stone unturned, but as a nurse, I want every stone unturned for all my patients and be healthy and have a long rewarding career and I can’t do that in many places in the current system.  So, when you ask whether patient safety is most important, I answer with ‘Yes, of course it is and making that a reality requires attention to staffing.’

A nurse researcher whom I admire,  Patricia Ebright, PhD, CNS, RN, FAAN shared this quote for the youtube:  Interruption Awareness:  A Nursing Minute for Patient Safety, “A commitment to understanding and appreciating the complexity of RN work is needed to guide the more substantive and sustained improvements required to achieve patient safety and quality”.

Having said all of that, I want to add that my text book which is due out late this summer, “Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers” will contribute to a stronger voice within the nursing profession. As such, I believe it will help with HAIs and many other issues.  I am passionate about patient safety and I so respect your work in that direction.

So what else can we do now?  Maybe we could start a campaign where consumers could get an inside glimpse of the work of nurses called ‘Walk a mile (or 10) in my shoes’. We’d have to make it safe for HIPAA and make sure the nurse and hospital want to give an honest view, but maybe worth talking about.  What are your thoughts?


I’m not convinced it is our place as patients to get in between you and your employers. We do our best to be our own advocates, to enlist loved ones to help us, but the bottom line is that patients need to be taken care of. We pay the bills to those who treat us for very serious and often life-threatening conditions if we are hospitalized. We need those hospitals. It might feel threatening to patients to speak up on your behalf, just as it is scary for patients to even ask physicians questions because of the fear that care will be compromised. I don’t believe that patients will take that risk. This is really an issue between hospital staff and administration.

It is not a big part of my work to educate patients and families on how to speak up to nurses and doctors to request hand washing. I wrote one post on that because a study was published which reported that most nurses and physicians do not welcome requests from patients/families to wash their hands. It’s uncomfortable for us to make requests for hand washing. We don’t want to have to do it. I certainly don’t.

Patient safety has to come first. From what you describe, hospitals and their employees are on opposite sides of the fence about this issue. I hear your frustration about not having what you need to implement patient safety standards. It’s a sorry situation and the hospital administration should be paying attention and giving their employees what they need to do the job they aspire to. I hear that and agree that something must be done. However, it feels like a boundary violation to ask the patients who are in dire need or might be at some point, to protest or intervene in this conflict.

Maybe there is another way to approach your superiors since past approaches have not worked. I don’t believe it is the patient’s place to get an inside view of what you go through to help you solve what is a work/insider problem. Perhaps your administrators should be enlisted to walk in nurses’ shoes. Maybe that should be a requirement before they take on the job. Maybe you and your colleagues could join together and present the problems and offer solutions. Maybe nurses’ unions could play a more important part in this problem.


I’d like to be clear that I’m not suggesting that patients, who I agree are dependent and vulnerable, should walk in our shoes.  I distinguish patients from consumers and perhaps there is or should be a better term.   Change agents need to understand the systems they are trying to change.  I wonder if Patient Advocacy programs educate about the complexity of the work.  Do you know?

Also, I  have ‘screamed’ many times with rare success (once) and more often messages to be quiet e.g.  “If you don’t like it here, there’s the door” or  “You need to manage your time better”.

I think your idea would work for administrators/leaders who are willing to listen and learn. Many are not and that is part of the underlying problem.

This is a frustrating place to end a blog duet.  A place of tension and conflict.  And yet, we put it out there to invite input from others, consider each other’s perspective,  and generate more topics to discuss.


Having completed and graduated from a patient advocacy program at UCLA, I did not hear much about nurses’ struggles. Perhaps that should be part of the curriculum since professional patient advocates who work in hospitals will be working with the nursing staff. But how that would manifest, I don’t know. Patient advocates who work in hospitals work for the hospital and their allegiance is to their employer. Independent patient advocates work for the patient. It sounds like nurses who work in hospitals need their own advocates or a team of advocates.

I did not understand that administrators/leaders don’t listen and simply blame nurses. Now I think I understand better why you are looking elsewhere for intervention. I still don’t believe that patients should be a part of it, but maybe there is another way to go. It would seem that the people with more power could be helpful. Perhaps hospital board members and investors could be informed about this pressing and ever-present problem and the reasons behind it. Perhaps if they were approached with detailed information about what you have described, how those internal problems affect the success and reputation of the hospital, how they affect patient safety and ultimately patient satisfaction (scores.) Perhaps then they would be amenable to your solutions and be willing to get involved.

Maybe you and other nurses are in unions. I don’t know if they are effective with a problem like this or not.


I think that we are uncovering some of the real dysfunction in our system and although it is frustrating to not have clear solutions for the seemingly simple problem of hand hygiene, I am inspired by your willingness to get closer to the truth of core issues.

I would be very grateful if we can hold on to discussion of unions and consumers’ role or patients’ role (and terminology) in evolving our healthcare system for future duets.  You raise a key point about power and yet even that is complicated because it raises questions in my mind about the power that consumers have and what happens when people in power refuse to listen?

I do think we could take an action step regarding your idea about patient advocacy programs and awareness of the struggles of (your term) or the complexity of (my term)  nurses’ work.  I propose that we draft a letter that WE can send to program leaders using hand hygiene as a persistent problem, asking for feedback about what is and isn’t in the program and maybe offering to develop a seminar or course.  I don’t know exactly what this would look like, but suspect it would be a valuable process for us.  If you agree, let’s work on that while waiting to see what other thoughts readers have about the hand hygiene issue!

6 05, 2015

Over Medicating the Elderly Patient: 10 tips for caregivers to protect patients

By | May 6th, 2015|Current Health Topics|0 Comments

Our 85-year-old neighbor, Dorothy, was taking 14 medications a day. She could barely get out of bed because of fatigue and mental confusion. With her adult children living out of state, my husband and I look out for her. Even with 24/7 caregivers, additional oversight is important.

When I spoke with her son, I strongly encouraged a medication review with Dorothy’s primary care physician (internist.) He soon visited and took his mom to her doctor, complete with a list of all her medications and dosages, over-the-counter medications, herbs and supplements. Her physician cut her prescription medications in half and changed a couple of others. Weeks later, Dorothy is nearly her old self again and is back to walking with her caregiver down our street.

Over-medication in the elderly is a serious and very common problem. According to The Journal of Family Practice, nearly 9 out of 10 U.S. residents who are over the age of 60 take at least one prescription medication. More than a third take 5-9 medications, and 12 percent take 10 or more. The risk of adverse drug effects and dangerous drug interactions increases significantly when a person takes more than 5 medications.

Such was the case with Dorothy. Several of her medications were causing side effects and those side effects were then treated with more medications. Multiple specialists were involved in her case and none communicated with one another. Each prescribed more medications to treat her symptoms. This is a phenomenon known as “the prescribing cascade.” Her caregivers did as instructed by helping her take her 14 medications a day and her adult children weren’t aware that “polypharmacy”  can be downright dangerous for the elderly.

Why is “polypharmacy” such a problem in the elderly? Aging affects how the body handles medications, meaning the elderly metabolize and eliminate medications less efficiently.

If you’re caring for an elderly patient who is taking multiple medications you need to know that they can be at high risk for drug related problems.

Following are 9 strategies to help:

1. If your elderly patient is taking multiple medications and sees more than one medical provider (doctor, nurse, PA, NP), create a list of all prescribed medications and their dosages. Include over-the-counter medications, herbs and supplements. In addition, add allergies to medications. Bring this list to each visit with the patient’s medical providers.

2. Ask the patient’s primary care physician to review the list of medications. Ask questions.

3. Talk to the patient’s pharmacist and ask for a medication review. A pharmacist’s training, education and expertise is in medications. They are there to help you. Ask questions.

4. Use one pharmacy to fill all of the patient’s prescriptions. Drug interactions, duplicate medications and allergies to medications will be caught.

5. Different medical providers might unknowingly prescribe duplicate medications for the patient if the patient does not present a list. This confusion can also occur with brand and generic medications. For example, the patient takes the generic, which has a different name than the brand. Both are the same medication. Medication samples are always brand.

6. Keep a symptom diary in partnership with the patient. If you notice new symptoms, keep a log of what the patient experiences on a daily basis. Ask the patient to contribute or if he/she is unable, document your own observations. Ask the following questions:

-When did the symptoms begin?

-Was a new medication started when symptoms began?

-How long do the symptoms last?

7.  Modern Medicine states that if the patient starts experiencing GI distress, it can be because of a new medication. Be on the look out for nausea, vomiting, diarrhea, constipation and stomach pain.

8. If there is a change in the patient’s mental status such as drowsiness, impaired memory, confusion, prolonged sedation, it might be because of medication. Some antidepressants, muscle relaxants, antispasmodics and antihistamines can also cause confusion, blurred vision, dry mouth, dizziness and difficulty with urination. Ask the patient’s primary care physician questions. Speak up.

9. If any of these or other symptoms occur, bring it to the doctor’s attention and show him/her the patient’s symptom diary.

10. If you are an advocate or caregiver for an elderly patient, it is very important to be informed about the patient’s medications. Older patients may see several different specialists who don’t communicate with one another and have no idea which medications the patient is taking.

Good resource: Beers Criteria (medication list) of potentially inappropriate medications for the elderly


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29 04, 2015

Will Cameras in the OR Improve Patient Safety?

By | April 29th, 2015|Real Stories|8 Comments

Real Stories from the Streets of Healthcare!

 Beth Boynton, RN, MS and Martine Ehrenclou, MA  

With patients and healthcare professionals all too often on opposite sides of the table, our goal is to bridge that gap. As a patient/patient advocate and registered nurse, Real Stories From the Streets of Healthcare is our way of discussing real stories and issues that involve patients and families, nurses, other healthcare professionals, and the healthcare environment itself.  We plan to look behind the closed door, break down walls of silence, and tackle thorny issues to increase understanding of the complex healthcare problems we all face.  See our welcome page for  more information about our blog duets here.

Below is our second duet.


The incidence of surgically related sentinel events, (or patient safety events) tracked by the Joint Commission is consistently high and there are three types that are in the top ten list of those most frequently reviewed;

  • wrong-patient, wrong-site, wrong-procedure
  • unintended retention of foreign body
  • Op/post-op complication

This has been true since the Joint Commission began tracking data in 2014.

So when I received a request to sign a petition to mandate cameras in the OR I felt compelled to look at it closely. I also felt torn.

On one hand putting cameras in OR seems like it might make the OR team more accountable for doing things properly and making sure they have the right patient, maintain sterile technique, and do not leave any foreign objects behind.  A level of accountability that cameras might indeed positively impact.

My hesitancy comes from worries about what the underlying problems are.  I worry that the underlying human dynamics going on are a primary problem and that we should do the work required to ensure that the team and organizational culture are safe, just, and respectful and that the surgeons and OR nurses and techs are practicing effective communication first.  If we put cameras in an operating room where there is bullying and blaming, what will cameras do?  They may stop overt mistakes, but those dynamics will not go away and are likely to surface in other creative (or destructive ways).  Maybe staff turnover would increase, (there is a steep learning curve for OR nurses) or last minute cancellations of surgery would become a frequent problem leading to delays in treatment and added stress, or there would be more documentation errors leading to loss of revenue, or maybe a patient’s surgical procedure would end up on Facebook.  I’m just guessing, but my sense of human nature is that if we don’t build healthy relationships, the negativity will ripple out somewhere.  Plus, I can’t imagine wanting to work in an environment of such close supervision unless there is a positive team dynamic.

This blogpost provides a little more info about the dynamics in the OR and some interesting similarities between the US and UK.

I think fixing the underlying problems and THEN putting cameras in the OR along with policies and protocols for ensuring privacy and being clear about use of recordings, i.e. to monitor standard operating procedures are followed and perhaps teaching.

What are your thoughts?


I too feel torn about putting cameras in the OR. For one, I don’t like the idea of cameras everywhere. Entire cities in the U.S. have video surveillance in effort to catch terrorists, to prevent vandalism at parks and other locations, catch drivers who run through red lights, and more. There seems to be a big push for the police to wear body cams. According to a report by the Department of Justice, “both officers and civilians acted in a more positive manner when they were aware that a camera was present.”  Today’s Los Angeles Times reported that the Los Angeles Police Commission approved body cameras for the LAPD.

As you pointed out, the number of sentinel events related to surgery is very high. For those who don’t know, a sentinel event results in a patient’s death, permanent harm or severe temporary harm and intervention to sustain life. You gave good reasons to support cameras in the OR in effort to make the surgical team more accountable. That just might make patients safer.

I think of the Dallas, TX, anesthesiologist who was supposed to be minding the patient during surgery but instead was texting and reading on his iPad. The patient died. It would seem that cameras in the OR would halt this type of behavior.

However, I also believe that cameras in the OR would only initially stop preventable medical errors. As we’ve witnessed on reality TV shows, the camera is soon forgotten.

You bring up some very valid concerns about real, underlying behavioral problems among surgical staff and how a camera in the OR might affect how those behaviors play out if the issues aren’t addressed. As you suggested, bullying and blaming might just surface in other insidious ways outside of the OR. I agree with you that a camera won’t build healthy working relationships if the root cause isn’t taken care of. In fact, I could see further destructive problems arising as a result of cameras in the OR.

You also brought up the frightening risk of patients’ surgeries being posted on Facebook. If it hasn’t happened already, surely it would.

However, I believe that patient safety must come first. As much as I don’t like the idea of cameras in the OR, I wonder if they wouldn’t force healthcare professionals to pay more attention to which part of the body is operated on, to the count of sponges after surgery to make sure none are left inside the patient’s body, to an instrument used in the surgical process to make sure it is accounted for and not accidentally left beneath the sutures.

I keep going back to the same idea—if there had been a video camera in the the surgical suite where Joan Rivers lay asleep on the operating table, would her doctor still have taken a Selfie with her while she was lying there completely unaware? Probably not.

Wholeheartedly, I agree with you that the underlying problems need to be fixed. But I wonder how long that will take. I wonder how long patients and their families can wait.


Excellent and provocative points, Martine.  The idea that a surgeon would take a ‘selfie’ with Joan Rivers lying there vulnerable is so disturbing.  And bizarre if you consider the idea that it is a camera that would (or at least, might) have prevented him from honoring a boundary that he was using a camera to break! Where was his sense of professionalism and respect for the patient and their therapeutic relationship?  And how would his inappropriate thinking and behavior manifested if he didn’t take the picture?  What need was he trying to meet?

Thank you for the Department of Justice report and your comments.  I find the ‘cameras everywhere’ to be a disturbing phenomenon.  Is this is a symptom of a world that is spinning out of control?  It raises so many questions about individual accountability, leadership, and privacy.  ‘We’ seem desperate to control things rather than creating platforms from which they can emerge healthily.  Maybe we need to do both in the world we are currently living in.

I am clear that I need to be assured that effective efforts to address interpersonal dynamics, organizational culture, and professional boundaries are in place and ongoing in order to advocate for cameras in the OR.  And I’m not talking about putting up signs that say “Professionals must behave respectfully”, or “ABC Hospital Maintains a Zero Tolerance for Bullying” but rather experiential learning techniques that develop people skills  and emotionally mature behavior such as Crew Resource Management, TeamSTEPPS, and Medical Improv while creating safe and just cultures that support healthy dynamics and collaborative.  These take time and effort, but aren’t impossible and there are many opportunities to be doing this all along the course of doctors and nurses’ education and careers.  IF we are willing to make it a priority.

Patients do deserve the best we have to offer and shouldn’t have to wait.


I understand where you are coming from about the importance of addressing the underlying problems. I agree that intensive learning techniques should be put in place. But perhaps both video cameras (temporarily) and learning techniques can be implemented at the same time. Cameras could be installed in operating rooms while mandatory classes/lectures for CEUs are offered by hospitals to teach members of the surgical staff about workplace bullying and its effects. Perhaps these classes/lectures could outline exactly what bullying and disrespectful behavior is, complete with live/videoed case examples about how it affects the surgical team as a whole as well as its members. It would also be important to illustrate how resentment from workplace stress trickles down to patients in the form of compromised quality and patient safety.
After disrespectful behaviors are fully understood by the surgical staff, then live or videoed case studies could be shown to teach healthy ways to deal with anger, frustration, and resentment. Effective and respectful communication strategies could be taught and each healthcare staff attendee could be asked to engage in “teach back” with the instructors or with one another about what they had learned. Perhaps after some learning had taken place, all healthcare providers could be asked to analyze different case studies to ID bullying and disrespectful behaviors and ID which behaviors are in fact appropriate and effective in reaching the goal.
Perhaps you and I could create courses like this with videoed case studies, a mini-text, tests, and either put them on ourselves or market them to hospital administrators that shows clearly how they will increase their bottom line. That’s the only way they’d go for it.
What do you think?
I think that is an excellent idea, Martine and would love to consider how we might do this.  I think healthcare professionals and hospitals might welcome some real-to-life videos that convey healthy vs. toxic behaviors.
What do readers think about cameras in the OR?
13 04, 2015

WebMD Interviews Martine Ehrenclou, Tips for Successful Doctor Visits

By | April 13th, 2015|Current Health Topics|1 Comment


Tips for a Successful Doctor Visit

By Camille Peri
WebMD Feature
Before a doctor appointment, you probably think of the things you want to talk about. 

In the shower, you remember that you should ask about those itchy bumps on your scalp. Or grocery shopping reminds you of a question about blood pressure. But then you’re there, sitting on the exam table with minutes of your doctor’s time, and you draw a blank.

“It’s difficult to recall symptoms or questions at a doctor visit because you’re nervous,” and that anxiety can mess with your memory, says Martine Ehrenclou, author of The Take-Charge Patient: How You Can Get The Best Medical Care.

You’re not alone if you squander your chance to pipe up. The average person asks five or less questions per doctor visit, says Sherrie H. Kaplan, MPH, PhD, co-director of the Health Policy Research Institute at the University of California School of Medicine in Irvine. And men are more close-lipped than women. They average zero questions per visit, she says. If it’s any consolation, “doctors are no better at it when they are patients.”

The more you participate in your doctor visits, though, the more you’ll get out of them.

“A good doctor-patient relationship isn’t just nice to have,” Kaplan says. “We’ve learned from studies that patients who participate more in treatment decisions have better health outcomes.”

These tips can help you speak up and have better visits.

Before-Visit Prep Tips

Unless you enjoy pop quizzes, prepare for your doctor visit in advance. Plan to bring with you:

  • Copies of medical records, if this is your first visit
  • Medications, vitamins, and supplements you’re taking, or a list of them
  • Information about recent medical tests
  • The names and contact information of other doctors you see
  • A list of your questions
  • A symptom diary

The more detailed you can make your symptom diary, the better. For instance, if you have stomachaches, Ehrenclou says, keep track of “when they began, when you notice them most, what makes them better or worse, if they coincided with an illness or new medication, and what you think may be causing them. Try to track them on a daily basis, or as best you can.”

Try these tips just before your visit:

  • Pick your top questions. You have a list of things you want to cover. Your doctor does, too. Chances are, you may not be able to cover all your questions in one visit. So pick the three or four concerns that are most important to you.
  • Rehearse at home. If it helps, practice giving your medical history out loud. Expect typical questions, like: What was the date of your last menstrual period? “Women always get that question from their ob/gyn doctor, and they’re almost never prepared with the answer,” Kaplan says.

Preparing not only saves precious time with your doctor — it also sets the tone for the visit. “Your doctor knows you’re taking health care seriously,” Ehrenclou says.

Top Doctor-Visit Tips

Here’s how to get what you want out of an appointment:

  • Get comfortable. If you’re tense on the exam table, tell the doctor or nurse what would help you relax. If you’d like a nurse, friend, or family member there, let the doctor know.
  • Be honest. Topics like sex or illegal drug use may be tough to discuss, but your doctor needs to know about them to give you the right care. Keep in mind, your doctor cannot discuss anything you tell him without your permission. Having a friend or family member there may make it easier.
  • Take time. The better you’re able to explain your concerns, the better your doctor can advise you about them. Stay focused, but don’t rush through a symptom if giving more information could be more helpful for your doctor.
  • Ask follow-up questions. If you don’t understand your diagnosis or treatment, speak up. If you don’t feel that you can follow through with a treatment, find out if there are other options. If you need someone who speaks your preferred language, let your doctor know.
  • Take notes. Or bring along a friend or family member to take notes or ask questions.
  • Find out how to keep in touch. Can you email your doctor? Or is it better to leave a phone message? Before you leave, ask for the best way to reach him if you have questions about what you’ve discussed.

Link to WebMD Interview of Martine Ehrenclou

31 03, 2015

The Doctor-Patient Relationship with Dying Patients (Published on KevinMD)

By | March 31st, 2015|Current Health Topics|2 Comments

Perhaps we thought we could get away with ignoring the relationship between doctors and patients. The Kaiser Health News article, “Efforts to Instill Empathy Among Doctors is Paying Dividends,” explains why we can’t.

Patient satisfaction scores and reimbursements aside, this relationship was once considered the cornerstone of quality care.

Doctors are healers but in recent years many have been reduced to diagnosticians, electronic medical records (EMR) data entry clerks, and health insurance appeal wranglers. They are so much more than that, but with 7 to 15 minutes per patient, it’s a challenge to fit in what used to be an intimate relationship with patients.

The changing face of health care has whittled down doctors’ relationships with patients to close encounters-of-the-impersonal kind. Physicians are fleeing their practices, selling them to hospitals, moving into concierge medicine, and more. Many are frustrated with how healthcare has changed the way they practice medicine. Some have found ways to salvage it.

A physician friend recently revealed to me that she doesn’t leave her office until 7:30 or 8 p.m. each night because of the EMR data entry program dictated by the hospital corporation that purchased her practice. She now has massive computer screens in each exam room. In her office, a towering computer screen looms over her desk. Seated in her once-comfortable office, I was startled by its presence.

With a sigh, she said, “It takes so much time to input patient information into the computerized forms. I can’t just type it out. I’m pigeonholed into forms and boxes that don’t allow me to just type in notes.”

With a dying patient, I wonder how much time doctors have to spend listening, waiting for patients to ask the questions instead of harnessing the conversations with their own. Atul Gawande so poignantly pointed out in his PBS/Frontline interview, Hope is Not a Plan, that conversations about end of life must include sitting with patients to allow them the space to reveal what is most important to them in their final days.

Dying is a lonely business for patients, which is why Jeremy Force, the first-year oncology student from the Kaiser Health News article, was so important to the dying cancer patient. He allowed for meaningful impact with that patient just by being present, by validating her experience, listening intently, and offering empathy. If that wasn’t life changing for him as well as the patient, I don’t know what is.

Jeremy Force used strategies he’d learned in a day-long course by Oncotalk, which is required of Duke University’s oncology fellows, as well as by University of Pittsburgh and several other medical schools. Dr. Force acknowledged what his patient was going through, provided empathy and employed active listening skills. In essence, he paved the way for the all important doctor-patient relationship.

A few days later, Jeremy Force ran into his patient in the hall of the hospital. She conveyed her appreciation and gratitude for his approach. The key, of course, is Force as a human being, ultimately revealed by his response. He said, “It was an honor.”

Maybe all doctors and patients can learn from this, push for the relationship between doctors and patients to be valued over data entry and reimbursements. We have to try.

Martine Ehrenclou is a patient advocate.  She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.


24 03, 2015

Time For an End-of-Life Conversation?

By | March 24th, 2015|Real Stories|0 Comments

Real Stories From the Streets of Healthcare!

With Beth Boynton, RN, MS and Martine Ehrenclou, MA

With patients and healthcare professionals all too often on opposite sides of the table, our goal is to bridge that gap. As a registered nurse and patient/patient advocate, Real Stories From the Streets of Healthcare is our way of discussing stories and issues that involve patients and families, nurses, other healthcare professionals, and the healthcare environment itself.  We plan to look behind the closed door, break down walls of silence, and tackle thorny issues to increase understanding of the complex healthcare problems we all face. See our welcome page for more information about our blog duet here

Time For an End-of-Life Conversation? 


Why is it so hard for patients/their families and medical providers to talk about end-of-life issues? Maybe we have created living wills, healthcare directives, & durable power of attorney for healthcare but too many people do not have a clear view of what it means to say, “I want everything done.”

If a patient has a life threatening illness and is on full life support with no hope for recovery, why do we keep putting the patient through aggressive medical treatment? All too often this causes the patient pain and suffering.

I went through this with my mother, my godmother and more recently with my uncle, see KevinMD article here. Each of them suffered miserably on full life support, with aggressive medical treatment, and the end of their lives was spent in a hospital room hooked up to machines. It was heart wrenching to witness.

What is this aggressive medical treatment about at end-of-life?


As a nurse, I’ve seen this kind of suffering too, don’t like being part of a process that prolongs it, and believe we can and should do a much better job. I also know that identifying what is ‘too much’ is tricky and varies among individuals.  Fears about death, challenging family dynamics, and some measure of uncertainty contribute to a perfect storm that leads us to treat.  

Your story about your uncle is heart wrenching and I think the docs, nurses, and administrators involved had many opportunities to be more responsive to him, his friend, and you on his behalf.  And that it is sad that they didn’t.

I think you are hitting on one integral problem, i.e. that people don’t understand what it means to say, “I want everything done” or “I don’t want to be hooked up to machines”.   This is complicated by unclear and even changing desires by patients, constantly evolving treatments and technology, limitations that healthcare professionals have in holding space for difficult conversations about death, and perhaps an overall lack of understanding or comfort with dying in our society.  The ‘truth’ is, we can help with alleviating pain and respiratory distress, but there is much we don’t know.  Maybe this involves a shift in our roles as healthcare professionals that we haven’t quite figured out.  Hospice practitioners have a better grasp of this I think.  It is a more supportive and less directive role than much of the work we do.  But people often resist hospice.  It is scary to hear and scary for some of us to suggest. 

Also, I think money is part of this picture.  We know that a lot of healthcare dollars are spent during this phase of life and this may be a disincentive, (consciously, subconsciously, or unconsciously) for facilities to let death take its course. 

I think seasoned docs and nurses may be more comfortable with clinical and interpersonal dynamics going on during death and more able to not intervene or be more thoughtful about responding.  Some professionals, and this is part of our training, are more geared to intervene.  React.  Treat.

I’ve seen Living Wills work well and not work well.  The portable ones of late make sense and do help with communication.  I also know that time can be an issue.  Do we have enough time and staff including continuity of staff to have the kinds of conversations that would help.  Listen.  Be with.

Sadly, on an understaffed unit, sending a patient from Med-Surg to ICU or from LTC to the ED may allow a nurse to take better care of others. We don’t consciously discuss this, but I suspect it is a factor at times.

I worked in long-term care for several years recently and wondered many times why we would initiate emergency treatment i.e. send someone to the ED as opposed to hospice.  These intersections, i.e. when someone is showing signs of septicemia or pneumonia are a somewhat predictable course towards death and is a time when tough, honest, compassionate conversation should take place between physician (NP, PA, RN) and patient/family.  If we made this one concept a priority, I think we could shift things considerably.  Perhaps we could ask questions about how this might unfold in the clinical setting and consider what training and staffing issues are raised.


21 03, 2015

The Take-Charge Patient’s Toolkit: free download

By | March 21st, 2015|Current Health Topics|0 Comments

Whether you are dealing with a new medical problem, an ongoing condition, or a serious illness, having a roadmap to guide you through the healthcare maze is invaluable.

The Patient’s Toolkit was developed to help you actively participate in care and engage with your doctors and nurses with more confidence.  You can download the toolkit here.  It is free.

The Patient’s Toolkit includes several forms, checklists and sample questions to guide you through key points in your medical care. It is a companion piece to my award-winning book, The Take-Charge Patient.

Your medical care is a team effort and you are a very important part of the process. To increase the quality and safety of your care, these easy-to-use and simple aids allow you to maximize the time with your medical providers and assist you to become more informed.

Many patients and their advocate families do not know how to navigate our complex healthcare system, how to ask questions or which questions to ask, how to track symptoms to support a physician’s efforts to arrive at an accurate diagnosis, make the most of precious minutes with a doctor, and prevent medical errors.

The Patient’s Toolkit is your personal guide. It includes a medical ID card that you can fill out and slip into your wallet so you have it with you at all times so you don’t have to depend on your smart phone or other electronic device. You can download the Patient’s Toolkit here.

If you are actively involved in your care and become informed about your diagnosis and treatment plan, you will experience increased safety and better quality care, according to the Health Affairs article, Patient Engagement

Ask questions if you do not understand something your doctor or nurse explains to you. Medical information can be complex and it’s foreign to most. Use The Patient’s Toolkit to document information about your diagnosis, treatment, next steps and when to follow up with your medical provider. Being prepared will increase your self-confidence and maximize the time you have with your medical provider.

I look forward to hearing from you about your success with your new Patient’s Toolkit. Your suggestions are welcomed.

For for information on The Take-Charge Patient: How You Can Get the Best Medical Care, please visit


21 03, 2015

Prevent Healthcare-Associated Infections: how to ask doctors and nurses to wash their hands.

By | March 21st, 2015|Current Health Topics|2 Comments

A new study from South Korea suggests that most patients and families are willing to remind hospital healthcare workers to wash their hands to prevent the spread of infection. With 1.7 million healthcare associated infections occurring every year and 99,000 deaths as a result, it could be a live-saving request.

Proper hand washing is the most effective way to prevent the spread of infections in hospitals, according to MedlinePlus.

The catch, according to the new study at the Seoul National University College of Medicine, is that many doctors and nurses don’t welcome a prompt to wash their hands. Only 26 percent of doctors and 31 percent of nurses supported the idea of patients’ requests to wash their hands. The most common reason for their resistance was concern about negative affects on the relationships with patients.

You’d think that doctors and nurses would be more concerned about spreading healthcare-associated infections that sicken their patients than damaging the provider-patient relationship.

With studies showing that healthcare workers wash their hands about 30 percent of the time, you bet I’d be willing to make the request. I’ve done it before and I would do it again. Is it uncomfortable? Yes. Is it worth it? You tell me.

I’d taken my daughter to the pediatrician for an ear infection, one of many that year. We waited in an exam room with the door open to view the front desk and another exam room. I watched as the pediatrician, who was subbing for my daughter’s regular doctor, touched two four-year-old twin boys in the exam room across from us. The boys were coughing like crazy. When she was finished, this doctor walked directly from that exam room and into ours. She headed for my daughter without stopping at the sink to wash her hands.

As she reached for my daughter, I stopped her and said, “Lucy’s been sick a lot this winter. Would you please wash your hands before touching her?”

Our eyes locked. There was a moment of subtext between us before she turned toward the sink and washed her hands. Was it worth the discomfort to prevent my daughter from possibly being infected with the illness from the two twin boys? Yes.

If you’re ever hesitant to make the same request for yourself, imagine you are doing it for your child or an older, vulnerable loved one. Keep in mind that it’s important to be polite when making the request. The doctor or nurse might have just have just forgotten while in a rush to get to the next patient.

Sample Questions to Use with Healthcare Providers

1. My loved one is susceptible to infection. I’m concerned about her health. Would you please wash your hands before touching her?

2. I’m concerned about the 1.7 million healthcare associated infections every year. I’m just trying to do my part to reduce them and keep myself safe. Would you mind washing your hands before touching me?

3. You’ve probably washed your hands already but I just can’t risk getting sick again. Would you please wash your hands? I respect you as a doctor (or nurse) but I just need to be careful.

It might sound like these questions are too carefully worded. It’s a given that patients deserve to be touched with clean hands and not subjected to possible infections. However, the bottom line is that most healthcare providers do not wash their hands nearly enough. Let’s just deal with the facts and go straight to increasing patient safety. And while you’re at it, wash your hands too. 

Regardless of any discomfort, ask your healthcare providers to wash their hands! It could save a life. 

For more information on patient safety, please visit

18 03, 2015

How to Create a Symptom Diary to Increase Your Chances for the Right Diagnosis

By | March 18th, 2015|Current Health Topics|6 Comments

Let’s say you go see your doctor because of symptoms you’ve had for a while. Maybe it’s stomach upset or pain in your knee. Perhaps you’ve put off making the appointment because you don’t relish the idea of seeing a doctor. There’s the waiting, 8-10 minutes with your physician, and the possibility of tests or a referral to a specialist.

When I see a doctor for symptoms, I know that I’d better do my part because I stand a 1 in 10 chance of being misdiagnosed. I understand that I have to track my symptoms in a symptom diary to give my doctor enough information so he/she has the best chance of giving me the right diagnosis the first time.

Try to keep a symptom diary for a week or so, longer if necessary. You’re not just actively participating in care but you’re offering your physician important information about your body. If you don’t prepare ahead of time, you’ll be asked to answer questions on the spot about your symptoms amidst ringing phones, patient emergencies and other interruptions. You might not be able to present a clear enough symptom profile. Do it when you have the time and space before you meet with your doctor.

How to Create a Symptom Diary

In a notebook, calendar, or app on your phone, keep track of symptoms every day. Describe the symptoms, their intensity, and when they appear. Ask yourself the following questions and document your answers:

1. Where on or in my body are my symptoms located?

2. Do my symptoms include pain? If so, then on a scale of 1-10, 10 being the worst, how bad is the pain?

3. When my symptoms first started, were they triggered by a physical event or new medication?

4. Are my symptoms constant or do they recede or disappear at certain times?

5. What makes my symptoms worse or better? For example, eating a meal or exercise.

6. What have I tried to make my symptoms better? Was anything successful?

7. What do I think might be causing my symptoms? Often we know our bodies best.

By offering this information to your doctor, you are supporting his/her efforts to arrive at an accurate diagnosis. If you are given treatment, be sure to report back to your doctor if you are not getting better. Following up with your doctor is important, as it can take a little longer to figure out the right diagnosis.

For for information like this, please visit



12 03, 2015

Patient Safety is a Team Effort: tips for patients to prevent medical errors

By | March 12th, 2015|Current Health Topics|4 Comments

As patients, we are not helpless to prevent medical errors. If we are proactive in our care and work in partnership with our physicians and nurses, we can in fact minimize medical errors.

It might not be in your nature to take charge of your healthcare, but if you think about the nearly 400,000 deaths every year in hospitals, you might change your mind. We can in fact work with our providers to ensure the safety of our loved ones and ourselves. Here’s how:


1. If you are a patient in a hospital, ask a loved one to be with you as much as possible during your stay. This person will assist you with asking your doctors and nurses questions, checking medications and their dosages, making sure your allergies to medications are documented in your medical record, ensuring that you are the right patient for the right treatment, and understanding the nature of your diagnosis and treatment plan.

2. Ask your loved one to document the names and contact information of the medical professionals taking care of you so you are able to reach them if you are in need.

3. Ask your loved one to help you prepare a list of questions for your doctor and nurses.

4. Take notes on conversations (or ask your loved one to do it) so you both can refer to the information when needed.

5. If something looks or seems different than what you have been told, ask questions before a treatment is implemented.

6. If you are scheduled to have surgery, ask your loved one to review the exact location of the surgery on your body with the surgeon, nursing staff or anesthesiologist prior to surgery. You can also mark the site on your body with a permanent marker.

7. Ask your loved one to be present when discharge instructions are explained, and ask that person to document after-care instructions even if an instruction sheet is offered. Especially important to note are new medications and appointment times with your doctor for a follow up appointment.

Medication Errors

1.5 million medication errors occur every year. The most common errors involve the wrong dose of a medication, which accounts for 41 percent of fatal medication errors. Being given the wrong drug accounts for 16 percent of errors. Almost half of fatal medication errors occur in people over the age of 60.

1. Create your own list of current medications and their dosages (include brand and generic names), over the counter medications, herbs and supplements. Include allergies to medications. Keep this list with you at all times and give this list to your medical providers each time you seem them. Your medications might change and that change might not be documented in your medical record. There can also be errors with input of your information.

2. When you are given a prescription for a medication, ask for the brand and generic names. Confusion can occur because generic names can be hard to remember and can sound like a completely different medication. Document the information you are given.

3. If your prescription is transmitted electronically to your pharmacy, compare your notes with the medication you receive.

4. Ask your doctor and pharmacist what the medication is for and how long you are to take it. Ask if there are dietary restrictions with the medication. For example, should you take it on an empty stomach or refrain from taking calcium supplements within a couple of hours of taking the medication?

5. Ask questions. If you don’t understand something about your medication, ask your doctor or pharmacist for information.

6. If a medication you receive looks different, ask your pharmacist questions. It might just be a different generic or it could be a mistake.

7. When you receive your prescription from your pharmacy, check the name on the bottle. A pharmacist I interviewed for my most recent book, The Take- Charge Patient, told me a story about a patient who didn’t check the name on the bottle and took two doses of a medication intended for another patient. Mistakes happen.

Misdiagnosis, Missed Diagnosis or Delayed Diagnosis

Diagnostic errors causing significant permanent injury or death are estimated in the range of 80,000-160,000 every year, according to Johns Hopkins Medicine.  They are more common and harmful than treatment mistakes. When patients see a doctor for a new problem, the average diagnostic error rate may be as high as 15 percent. 

1. To assist your physician with arriving at a correct diagnosis, create a symptom diary for a couple of weeks (if possible) before you see your doctor. My Patient Toolkit can help you. Free download here.

2. Describe your symptoms and where they are located on or in your body.

3. When did they start? Was there a physical event or new medication associated with your symptoms?

4. Note what makes your symptoms worse or better, such as eating a meal or exercise.

5. Do you have pain? If so, rate it on a scale of 1-10, 10 being the worst.

6. Note what you think might be causing your symptoms. Often we know our bodies best.

7. Bring this information with you when you see your doctor and share it with him/her. Have a discussion about your symptoms.

8. If you are given a diagnosis, you can ask, “What other diagnoses could possibly explain my symptoms?”

9. Ask for your test results! If you haven’t heard from your doctor’s office, it does not necessarily mean good news.

10. If you doubt your diagnosis or aren’t getting better from the prescribed treatment, communicate this information with your doctor.

11. Consider getting a second opinion from a qualified specialist. Gather copies of your tests to bring with you to see that new physician.

12. Ask for your tests to be read by another physician or to be repeated. 

Healthcare Associated Infections (HAI)

Healthcare associated infections result in 1.7 million infections and 99,000 deaths each year.

1. Whether you are in the hospital, doctors office or other medical facility, ask everyone involved in your care to wash his or her hands before touching you. This might be a little uncomfortable, but you can simply say, “My immune system is not strong right now. I am susceptible to infections. Would you mind washing your hands before touching me?” If your loved one is with you, she/he can make the request.

2. Make sure you wash your own hands thoroughly and frequently when in a hospital, doctor’s office or medical facility.

Taking charge of your healthcare means taking charge of you as a patient and working with your medical providers to increase patient safety and quality of care.

For more information, please see

7 02, 2015

Killer Supplements: major retailers found selling fake dietary supplements

By | February 7th, 2015|Current Health Topics|8 Comments

Four national retailers were blasted by the New York state attorney general’s office with demands to remove their popular store bands of dietary supplements from their shelves. Tests were run and the results showed that roughly four out of five products contained none of the herbs listed on the labels. Some contained little more than fillers like rice, powdered garlic, and ingredients that could be dangerous to people with allergies.

Wal-Mart, GNC, Target and Walgreens were accused of selling herbal supplements that did not contain herbs. That constitutes fraud. Unlike prescription drugs, the government does not regulate the safety and sale of supplements such as Ginkgo Biloba, St. John’s Wort, Ginseng, Echinacea, and others, because they are classified as food products, not medicines. Not that I have total faith in the FDA’s regulation of pharmaceutical drugs—I don’t, especially regarding generic medications imported from India and other countries.

Over half of the U.S. population takes dietary supplements, according to the CDC. You have to wonder how many people had allergic reactions or developed side effects from  the non-disclosed ingredients in the fraudulent products in New York. How many may have occurred and went unreported? 

According to Slate, many people think that because herbs are “natural” and sold legally that they must be safe and effective. Maybe that’s why so many of us blindly trust herbal supplements. It’s a bit mind-boggling that we do since no one really knows what’s in any of them. There is a general mistrust of the FDA and pharmaceutical drugs but not about the quality of ingredients in dietary supplements, at least with the general public. Not too long ago I had a conversation with a woman in a health food store who protested when I mentioned that the supplements she was devoted to were not regulated in any credible way. She said, “I hope they are never regulated.”

There seems to be an ingrained loyalty and trust in these dietary supplements, and with over half of our population taking them, there must be a reason. Is it because these products are readily available to anyone and we are not dependent on physicians to use them? We rely on doctors for prescription medications and that’s not without seeing us in person and performing an exam and evaluation.

Is it because we want to heal ourselves? We can visit any GNC or Walgreens to buy remedies that promise weight loss, increased mental alertness, increased libido, and a good night’s sleep. Could it be that innately we know our bodies best and need some control over treatment for what ails us?

It’s a bit baffling that we have placed so much trust in companies like GNC, for example, whose products labeled Ginkgo Biloba only contained rice, asparagus and spruce—as in the tree.

At Target, products labeled St. John’s Wort and Valerian Root tested negative for herbs listed on the labels. The list goes on.

Where this gets dangerous is when products contain ingredients that people might be highly allergic to or could cause harm in other ways. According to the research published in the Journal of the American Medical Association in October of 2014, researchers found anabolic steroids in 85 percent of body building and sports enhancement supplements. This gets downright scary.

Does having access to supplements that promise cures make us feel more in control of our health? Are we seeking to heal ourselves because we don’t trust doctors or can’t afford to see them? Why put blind faith in a product we know zero about?

I support self-healing whenever possible. I believe in patient empowerment. I also have faith in certain alternative treatments. But don’t consumers deserve to know what’s in supplements taken by over half of the population?

I’ve seen alternative medicine practitioners myself, such as acupuncturists and chiropractors. When I had a severe, lower abdominal pain condition lasting 16 months that no physician could diagnose or treat, I turned to them. I drank smelly teas, ingested capsules containing powdered ingredients with names I could not pronounce–all in hopes that the debilitating pain would subside. Nothing helped.

With all good intentions these practitioners tried to alleviate my pain with their herbs and supplements. Of course that wasn’t possible (something we didn’t know at the time) because what I had was a muscle tear in my C-section site with nerve involvement and an inguinal hernia with a nerve passing through the hole. A hernia specialist/surgeon fixed that and I’ve been pain free for 3 ½ years.

It’s frightening to look back on an acupuncturist I saw back then, one who was recommended by a physician at a highly respected medical school. After taking the supplements he gave me, I developed allergic reactions such as itchy ears, swollen glands, and sinus problems. I understood then that no herbal supplement was regulated. But I took them anyway because I was desperate, needed hope, had to believe the practitioner who recommended them.

Like anyone else, I fell for the promise.

We do need regulation on dietary supplements. Not just to protect consumers from swindlers making false claims but to protect our health, especially for those who have life-threatening allergies.

If you’re wondering about your own dietary supplements and if they are viable, you might check The U.S. Pharmacopeial Convention (USP), a scientific nonprofit organization that sets standards for the identity, strength, quality and purity of medicines, food ingredients and dietary supplements. See link here You might also try see link here I don’t claim any responsibility for the information from these two organizations. 

I welcome your comments.

For further information, please see The Take-Charge Patient.

19 01, 2015

The Year Of The Patient: 10 tips for safer, higher quality healthcare

By | January 19th, 2015|Current Health Topics|4 Comments

With the New Year, many of us have an eye on new beginnings, from weight loss and increased exercise to work productivity strategies. Maybe you’re even thinking about how to take better care of yourself.

One important self-care strategy is related to your healthcare. 2015 is the year patients and their advocates/caregivers can do their part to increase the quality of care, maximize the time with doctors and nurses, and increase their chances of accurate diagnoses and safe medical encounters.

Healthcare is becoming even more complex with the implementation of the Affordable Care Act and many providers have even less time to spend with patients. This means that if we want higher quality care, we must be proactive and partner with our providers. If we actively participate in care, discuss treatment options with our doctors and nurses, and share in decisions, we are more likely to experience  successful, pleasant and safe medical encounters. 

 10 strategies to help you in the coming year.

1. Get organized. Gather copies of of pertinent medical records such as MRI, CT scan, blood test results, and any surgery or procedure reports. Put them in a health file at home. This allows you to retrieve a test when you need it, and not depend on a busy doctor’s office or facility to forward your records. Get copies of your records for yourself so you are in control.

2. Understand your health insurance plan. No one likes surprise medical bills so ask questions about what your plan covers, the amount of your deductible, if there is co-insurance and what that percentage is and when it applies, and which medications your plan covers. There have been a number of changes in health insurance and you might not be aware of them. Call your health plan’s customer service number and ask questions.

3. Prepare a list of questions before you see a doctor or nurse. If you prepare ahead of time, this allows you to think about what you want out of the medical encounter. Write down questions or input them into your smart phone. We’ve all experienced forgetting questions and later calling our medical provider to retrieve information. Document what your doctor or nurse explains so you can refer to the information later. It can be stressful seeing a provider and stress interferes with cognitive function, namely memory.

4. Do your part for an accurate diagnosis. Diagnoses that are wrong, missed or delayed are believed to affect 10 to 20 percent of cases. If you are seeking a diagnosis from your doctor, create a symptom diary ahead of time. Track your symptoms on a daily basis. List the following:

-Where on or in your body your symptoms are located.

-When they started and if there was a physical event before or at the time symptoms developed.

-Note what makes them worse or better (such as exercise or eating a meal), when they occur or if constant.

-Document pain (list pain on scale of 1-10, 10 being the worst) and when it occurs.

-Note what you think might be causing your symptoms.

Share this information with your provider. The more information you offer, the more likely you’ll receive an accurate diagnosis.

5. Do your part to prevent medication errors. According to the Institute of Medicine, 1.5 million people are harmed by medication errors every year. Create a list of your current medications and their dosages, over-the-counter medications, herbs and supplements, and allergies to medications. Bring this with you to each medical encounter.

6. Ask questions. If you don’t understand something that is explained to you by a medical provider, ask for clarification. This does not imply that you aren’t smart. It implies that you want to understand. Medical information can be complex.

7. Do your research. Find out as much as you can about a medication, proposed diagnosis or treatment plan. This is important so you are informed.

-Ask your doctor for information.

-Research on credible websites.

-Ask questions of other patients who have the same diagnosis or treatment. Online patient communities can be helpful.

-Go to your local library for information. Ask the librarian or medical librarian for assistance.

8. Get a second opinion. If you question a diagnosis, if surgery is recommended, or if you have a serious illness, get a second opinion from a qualified specialist who is board-certified and affiliated with a respected medical school.

9. Use your pharmacist. If you have unanswered questions about your medications or are having difficulty managing them, make an appointment with your pharmacist and ask for help.

10. Bring a loved one with you to a doctor’s appointment. Ask this person to document answers to your questions so you can refer to it later. If a loved one accompanies you, you’ll feel less nervous about asking questions.

Let’s make 2015 the year of the safe patient!

Happy New Year! Best wishes for a safe and prosperous 2015.


28 11, 2014

Soaring Generic Drug Prices: 8 tips to save on your medications

By | November 28th, 2014|Current Health Topics|11 Comments

80 percent of prescriptions in the U.S. are for generic medications. Generics are supposed to be less expensive alternatives to brand name drugs. However, prices for certain generics are rapidly increasing. 50 percent of generic medications increased in price in the last year and 10 percent more than doubled in cost during the same time period. Among them are thyroid replacement hormone, doxycycline, digoxin and other heart medications, tetracycline, albuterol (pill form), and certain medications for blood pressure and high cholesterol.  

I thought generics were supposed to offer a lower-cost alternative to brand name medications. Pharmacists are reporting seeing generics priced similarly to the brand name of the same medication.

Something is wrong here. Apparently Vermont Senator Bernie Sanders and Maryland’s Elijah Cummings were concerned enough to investigate why generic drug prices are soaring. A hearing of the Senate Subcommittee on Primary Health and Aging was called to probe for answers and incite action last Thursday.

In addition, many brand name medications for asthma, COPD, diabetes, as well as heart medications, cancer treatments, hormones and nasal sprays, will no longer be covered by health insurance plans in 2015. Brand name medications are cost prohibitive. Now, certain generics are too, and patients are being forced by health insurance companies to accept less expensive alternatives to the medications their doctors have prescribed or not take them at all.  

This is not what our medical providers want. Doctors are handicapped enough already by health insurance denials. Even pre-authorizations for prescription medications are now often turned down.

Take my husband, Jamie, who was given samples of Celebrex for pain. When those ran out, he tried to fill the prescription for the same drug. Our health insurance company, HealthNet, turned that down even after a pre-authorization was done by his doctor’s office. He was offered Meloxicam instead, which is not nearly as effective as Celebrex in reducing his pain. He limps along.

Our pharmacist explained that until Jamie has tried two more alternative prescription anti-inflammatories, that HealthNet will not approve Celebrex. The generic for Celebrex is not yet available. Our pharmacist also said that even when the generic is available (in December of this year) that it might be almost as expensive as the brand. That could mean that HealthNet will not approve that either.

Unless your health plan’s drug formulary covers your medication, you might be out of luck. A drug formulary is a list of prescription drugs, both generic and brand, that are preferred by your health plan.

If you’re shopping for health plans now during open Open Enrollment (November 15, 2014-February 2015) you might ask if the medications you take regularly are covered. No one wants to be surprised by an unexpected medical cost.

Tips to Help You

1. When shopping for health insurance plans, ask if your regular medications are covered by the plan.

2. Mail order pharmacies tend to be less expensive than retail pharmacies. 90-day prescriptions tend to be less expensive than monthly refills. 

3. Some pharmacies will give you discounts on certain medications. Ask your pharmacist.

4. Ask your medical provider for samples. This is only useful for time-limited treatment. All samples are brand name medications.

5. Consider asking your doctor for a higher dosage of your medication and split it in half. However, there is controversy around this tip. For example: you are supposed to take a 10mg tab. Ask for a 20mg tab. Check with your doctor and pharmacist before splitting pills. It’s only safe for certain types of tablets. 

6. Drug manufacturers will sometimes offer discounts for brand medications. Go to the medication name website and type in discount. For example: There will be an explanation of the discount you can receive and under what conditions.

7. There are discount prescription programs to help offset the cost of your medications if you can’t afford them, such as Rx Assist  and Needy Meds

8. Ask your pharmacist for help with reducing the cost of your medication.


23 11, 2014

Should Consumers and/or Patients Provide Empathy for Nurses and Doctors?

By | November 23rd, 2014|Current Health Topics|10 Comments

Guest blog by Beth Boynton, RN, MS

Before trying to answer this question I need to differentiate between my use of the terms ‘consumer’ and ‘patient’.  I’d like to use the term ‘consumer’ to include all of us who may receive health care service and ‘patient’ to include those who are actively being treated at any given moment.  The need to make this distinction will become clearer as we consider the topic.

It seems obvious that collaboration between healthcare professionals, consumers, and patients is our best hope for fixing problems like making care safer, kinder, and more cost-effective. Yet in order for this to happen, healthcare professionals must try to understand what patients need and want in terms of their care so that we can provide the best care, patients should speak up as best they can to tell us, and consumers need to understand as much as they can about how our healthcare system works (or doesn’t work) so that efforts to change will be based on solid ground.  

While patient-centered care is an approach that is helping gear clinicians to listen to, respect, and empower patients, I wonder how we might reach out to consumers to invite them to learn more about the work that nurses, doctors, and other healthcare professionals do, how it affects us, and consider how they might be supportive. Empathy for healthcare providers seems important in the pursuit of collaborative care and the dismantling of the old ‘us and them’ paradigm.  

Yet, there is a big caveat to this and it presents a paradox that leads me to write and hopefully inspire discussion about it. When consumers are patients it is the job of healthcare professionals to take care of them.  Not the other way around.  There is an inherent dependency involved in the relationship and it does not seem right for nurses and doctors to expect patients and families to be empathic about their challenges when patients are sick and/or vulnerable.  On the other hand, not making room for empathy may interfere with truth finding and problem-solving that we could be working on together.  

For example, healthcare employers often tell nurses via customer service training that they should never tell patients that the organization is short-staffed.  Nurses are running around from urgent task to urgent task.  Patients and families have reasonable requests and sometimes urgent needs that go unattended for too long. Instead of providing more staff there are memos to discourage overtime and care providers are given critical evaluations for lack of time management skills. Workarounds are never openly advised, but there is not enough time or staff to do things properly. Shortcuts become taboo to talk about, common, and unsafe. It is frustrating, sometimes extremely frustrating and I don’t know any colleagues who feel good about making patients wait for pain medication, leaving work for the next shift, or forgetting to give a critical antibiotic.  

I have two thoughts about this conundrum.  One is that patients and consumers deserve to know the truth.  This way they are empowered to help or get their care elsewhere. In fact, I’ve often thought that organizations facing budget constraints should work with a consumer group to come up with a plan of how family members,  volunteers, and even administrative leaders might help during a nurse staffing shortage. Nurse Assistant training is only 6-8 weeks and could be a prerequisite for working in a hospital or nursing home.  That way there would always be help available and things that get delayed would not include patient care. Alternatively, hospitals and nursing homes could just be honest. “We welcome you and there is a bed, but you should probably bring someone with you to help the nurses and nurse assistants because we had someone call in sick for duty.”

The other thought is that at some point consumers should know how such conditions affect the people they are entrusting their care to and the health care systems they depend on. Burnout, substance abuse, and even suicide are tragic and interrelated problems that healthcare professionals face. And maybe empathizing with the frustrated nurse or doctor isn’t appropriate when being cared for, but maybe simple efforts such as getting to know neighborhood nurses and doctors on a deeper level would help. Conversations outside the clinical environment between consumers and healthcare professionals that help discover emotional or physical stressors may create doors for authentic and co-creative problem solving might help.  

I don’t have an exact answer to this question about empathy, but I do believe that we all deserve and maybe even need it. Honesty should be a priority and seeking answers will somehow help us to move forward toward a collaborative vision of healthcare that is safer and more compassionate. What thoughts do you have?

Beth Boynton RN, MS is a national speaker, consultant, and the author of “Confident Voices:  The Nurses’ Guide to Improving Communication and Creating Positive Workplaces”.  She specializes in communication, collaboration, & emotional intelligence for healthcare professionals and organizations and is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. Her video, “Interruption Awareness:  A Nursing Minute for Patient Safety” and blog, “Confident Voices in Healthcare” have drawn audiences from all over the world.  She is currently writing a core text on communication for nursing students with F.A. Davis Publishing Co which is tentatively scheduled for publication in the Spring of 2015.  Her complete CV is online. 



19 11, 2014

Doctored: The Disillusionment of an American Physician by Sandeep Jauhar

By | November 19th, 2014|Current Health Topics|2 Comments

As an avid reader of physicians’ memoirs, I dove into Sandeep Jauhar’s, Doctored: The Disillusionment of an American Physician, prepared for an unveiling of our dysfunctional health care system. I half expected to fall into a story about a physician who pursues his passion for practicing medicine in the face of overwhelming odds and surfaces as the victor. That isn’t what Doctored is about. It’s value lies in the author’s ability to let readers see behind the curtain of a physician’s life and pursuit of a profession that isn’t what it once was. Although not hopeful for physicians and patients alike, Doctored is a moving and well-written memoir that showcases the author’s struggle to practice medicine while confronting a number of personal and ethical challenges.

Because I’ve interviewed so many physicians for my books, The Take-Charge Patient and Critical Conditions, I understood the author’s exasperation with the time-crunch with patients, low reimbursements from health insurance, frustrations with health insurance denials, and massive amounts of paperwork. I’ve heard the same from almost all of the doctors I’ve spoken to.

As a cardiologist at a teaching hospital outside of Queens, Sandeep Jauhar struggles to earn an income to support a wife and growing family. He deals with unscrupulous doctors who over-test for profit and in the name of defensive medicine. He is a physician trying to do the right thing by his patients but at the same time earn enough money to put food on the table. Unlike many of his cohorts who take it for granted that prescribing unnecessary tests for unsuspecting patients is the only way to increase their incomes, Jauhar questions his journey as a cardiologist, challenges the idea of using patients to bilk health insurance companies.

However, Jauhar does in fact join the peccant group of physicians who compromise their integrity to make more money. What saves him from being an unlikeable narrator is his conscience, his discomfort with selling out.

Jauhar casts a dark shadow on many physicians, calling our attention to ulterior motives to boost referrals, another word for kickbacks from other doctors. He writes, “Referrals are also a way for cash-strapped doctors to generate business.” Giving an example of three physicians who all agree to call one another when an issue with a patient arises that is outside the scope of their expertise, he offers a clear picture of the dirty referral process. “It’s hard not to view a referral as an overture from another physician, and it is equally hard not to return the favor.”

Ever wonder about your doctor’s referral to a specialist? Read this book and you’ll find out information to consider.  

Jauhar is certainly caught in a bind, not unlike many other doctors who go into medicine because they want to care for patients, only to discover they can’t manage financially unless they make other choices. In conflict with the business of medicine, Jauhar reveals the underbelly of the physician population. He takes on work for cardiologists who perform needless stress tests for young patients, echocardiograms, and more.

His family pressures him to socialize with other doctors in effort to snare referrals. Jauhar is judged for resisting the doctor parties that lead to financial rewards, for not wanting to use tried and true strategies for manipulating others for gain. Contrary to his integrity, he does it anyway.

Throughout Doctored we are privy to interesting patient stories to illustrate ethical challenges faced by Jauhar. There are morality tales in the cardiac wing of the hospital, in treating end-of life patients whose families want them to survive no matter what, in sending patients to specialist after specialist in effort to find an accurate diagnosis for what ails them.  

Jauhar’s doubts bleed into the competency of other physicians and their ability to accurately diagnose. His own father suffered with chronic headaches. After a slew of prescribed drugs, from muscle relaxers and antidepressants to prednisone, his father then submitted to a battery of tests requiring a hospital stay. Those tests turned up very little in the way of a diagnosis. His father was seen by an array of specialists but “no one could tell him what was wrong.” Even when his father’s doctor did show up to see him in the hospital, Jauhar writes, “she spent no more than a couple of minutes with my father then rushed off.”

All of us patients can relate to that.

Jauhar’s father eventually stopped the medications on his own and after two weeks the headaches disappeared. So much for modern medicine.

When Jauhar’s wife, Sonia, was pregnant with their second child, the chief of obstetrics at Cleveland Clinic performed a fetal ultrasound. They were told the baby was a girl. That opinion turned out to be wrong. They were having a boy, a fact conveyed by a Rastafarian man on a beach in Anguilla where Jauhar and his wife had vacationed previous to the ultrasound. The significance of this portrayal is greater than one might think. It sheds light on a deeper premise in the book—that even the best doctors can be wrong, and someone with no medical training can get it right.

Jauhar laments diagnostic workup of the past and explains that diagnosis used to be based on observation and physical exam of the patient. He points out that these tools appear to be obsolete today and states that doctors are so uncomfortable with uncertainty that they rely on tests and numbers. The obvious is overlooked, not just because of physician over-confidence but because of fear of missing something that might result in being sued for malpractice.

Using his own misdiagnosis of a patient as an example of how physicians mistakenly come to erroneous conclusions, Jauhar describes a patient, an intern, who sees him for chest pain. He shows us how easily misdiagnosis comes into play by his own diagnostic error. This patient did not have pericarditis as Jauhar thought, but a heart attack. Jauhar missed it, causing the patient to suffer through the night with extreme pain. After discovering his faulty diagnosis, he even acted in ways that some doctors might when first learning of their own misdiagnoses–he initially blamed everybody else.

Jauhar writes, “Most doctors are afraid to take responsibility for medical errors.” However, he does eventually do the right thing. This is where we align with him, feel empathy toward an imperfect human being. He admits his mistake to his patient and says, “I thought you had pericarditis. I was obviously wrong. I’m sorry.”

Assuming the patient would not want to be treated by him again, Jauhar asks if he’d been given a referral to another cardiologist. The patient insisted on sticking with him as his doctor. And the point is clear that it is the apology, the relationship between doctor and patient, which increases patient loyalty and reduces potential malice when a medical error occurs.

Most patients have been treated like objects at one point or another so many will relate to Jauhar’s description of patients dismissed by doctors who just don’t care. He recounts a conversation with a nurse about the assumption that most patients are unwilling to ask questions and divulge personal information to doctors, something they do with nurses. When asked why, the nurse responded with, “Because they have a relationship with me.”


Jauhar consistently alludes to the lack of time for the doctor-patient relationship, something that is still considered a cornerstone of quality care, even the heart of care. He draws the conclusion that it is the time pressure that contributes to medical errors and the lack of physician and patient satisfaction.

Doctored isn’t a comfortable read, but a compelling one. I found myself not wanting to continue reading at times, overwhelmed by the road blocks doctors and patients face today. There were times when I felt slimed by the horror stories about deceptive physicians, wondering just how much of the same I’d been subjected to as a patient with a chronic pain condition lasting 16 months when I received 10 misdiagnoses from 11 physicians.

Jauhar does offer a few solutions to overuse of health care and to dwindling time with patients. I won’t go into all of them, but I’m happy to report that better-informed patients are one of the more potent solutions that Jauhar recommends. “If patients are more involved in medical decision-making, there would be more restraints on doctors’ behavior, thus decreasing unnecessary testing.”

Not exactly the reason I was hoping for but active participation on the part of the patient is crucial to increasing quality of care and safety.







7 10, 2014

Ebola Virus Must Be Stopped at Source: aid organizations need our help (updated)

By | October 7th, 2014|Current Health Topics|2 Comments

There have been eight diagnosed cases of Ebola in the United States. A Liberian patient died because of the disease on October 8 in a Dallas, Texas hospital. Two hospital employees who cared for him have been infected with the Ebola virus. More than 8,900 people in Guinea, Liberia, Nigeria, Senegal and Sierra Leone have contracted Ebola since March, according to the World Health Organization (WHO.) More than 4,400 people have died because of the disease. 

The only way to contain the Ebola outbreak is to address it in West Africa. “We have to stop it (Ebola) at its source. That’s the only way to get control,” said the director of the CDC, Tom Frieden. “As long as there is a major epidemic in West Africa, the rest of the world is at risk.”

West Africa is facing the worst Ebola outbreak in history. The WHO reported on October 14, 2014, that the number of new Ebola cases in Guinea, Liberia and Sierra Leone could reach 10,000 a week by the end of this year. The CDC predicts that by January of 2015 there will be 1.4 million cases of Ebola in Sierra Leone and Liberia alone. The World Health Organization (WHO) has declared it an international public health emergency. 

What some might not be aware of, is the bigger picture. This outbreak becomes even more critical if the virus continues to spread in West Africa at its current pace. If it does, then much larger global outbreaks of the Ebola virus will become more likely. This could pose a significant risk to the U.S. and other countries in the coming months. Ebola needs to be stopped before it becomes a pandemic.

There is no widely available vaccine or treatment for Ebola. The WHO reported that more than 400 health workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and  200 have died. There are shortages of medical staff and protective medical equipment for health workers in West Africa.

In the absence of an available vaccine or cure, the only way to contain the outbreak is through isolation, reports Scientific American. “In order to halt the calamitous chain of transmission, at least 50 percent of all infectious Ebola patients in West Africa would need to be isolated and kept from infecting other individuals.”    

Aid organizations, partnering with the WHO, have deployed doctors, nurses, and medical supplies to the affected countries. They are providing health care services, educational programs and mental health support.  

Because there is a shortage of doctors and nurses in West Africa, medical personnel are volunteering to fight the Ebola virus there. There is a desperate need for more volunteers to staff hospitals and clinics, and to provide education to the people who live there.

In response to relief efforts to West Africa, Doctors without Borders/MSF reports, “critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contract tracing, epidemiological surveillance, alert and referral systems, community education and mobilization.”

The United Nations (UN) officials called the Ebola crisis unparalleled in modern times.

Aid organizations need our help so they can train and deploy more volunteers to the affected areas in West Africa. Organizations such as Doctors Without Borders/MSF, The American Red Cross and UNICEF, among many others, are providing health care, education programs, emotional support, medical supplies, and more.

Doctors Without Borders/MSF has sent response teams, including many doctors, who are treating the sick. MSF currently has 3,058 staff working in affected countries. They operate six Ebola management centers and provide more than 502 hospital beds, and more.

The American Red Cross is leading disease prevention education and awareness efforts. They just opened a new clinic to fight Ebola in Sierra Leone. Thousands of International Federation of Red Cross volunteers have been trained and deployed to support the response. They are in the process of training more than 5,600 volunteers to reach a larger geographical area.

One aspect of this devastating crisis that many of us don’t know about, is the 3,700 children in Guinea, Liberia and Sierra Leone who have lost one or both parents to Ebola. According to UNICEF, these children are in urgent need of attention and support, especially because in some communities the fears about Ebola have driven families apart, leaving orphaned children abandoned. UNICEF helped the Liberian government train 400 additional mental health and social workers and have supplied 550 tons of supplies to the affected areas. 

Following is a list of non-governmental, charity organizations that are involved in relief efforts in the Ebola-affected countries. Even though our government has increased its efforts to help contain the Ebola crisis, President Obama emphasized the need for help from nonprofit organizations to effectively fight it.

This is where you and I come in. I donated to two organizations. Please consider giving your support.

This is by no means a complete list. I do not endorse any of these organizations. This list is provided for your convenience. 

Charity Organizations Providing Relief Efforts in West Africa to Fight Ebola



American Jewish World Service

Amref Health Africa   

American Red Cross

Catholic Relief Services;jsessionid=A05BB59D666073899A68B908C7752BEF.app262b?7200.donation=form1&df_id=7200&s_src=one   

Doctors Without Borders   

Medical Teams International

Med Sans Frontieres/Doctors Without Borders



More Than Me

National Nurses United

Partners in Health      

Samaritan’s Purse


Photo by John Moore, Getty Images











29 08, 2014

Patients’ Medical Records Hacked at Alarming Rate: tips to protect yourself

By | August 29th, 2014|Current Health Topics|0 Comments

The medical industry has suffered more security breaches than banks and the military combined, reports CNN, 90% of Hospitals and Clinics Lose Their Patients’ Data.

Just this year alone, 2.1 million patients’ medical records were stolen. That doesn’t include the major hacking into Community Health System’s computer network where 4.5 million of its stored social security numbers, names, addresses, and birth dates were lifted.

Community Health Systems operates 206 hospitals across the United States. Anyone who received treatment from a physician’s office tied to a network-owned hospital in the last five years has been affected.

This is not good news, that’s for sure. And it doesn’t look like it’s getting better any time soon. Hackers are becoming more sophisticated and they stand to gain a lot from hacking into your personal medical information. They make plenty of money by stealing medical records with social security numbers to commit identity fraud, open bank accounts, new credit cards, take out loans and ruin personal credit histories. Not to mention fraudulently billing health insurance companies, including Medicare, and harvesting prescription medications that can be sold for profit on the street.

Hackers are stealing patients’ medical records and private information from hospitals, universities, private clinics, health care organizations and health departments.

How does this happen?

62 percent of health care organizations are moving patients’ electronic medical records to cloud storage without proper security in place. Open WiFi is also a problem. Health care providers use WiFi networks to allow staff to share patient information more easily and these WiFi networks are not secure as they should be, according to a Huffington Post article, Why Your Medical Records Are No Longer Safe

The 4th Annual Benchmark study done by the Ponemon Institute reports that 90 percent of health care organizations had at least one data breach within the last two years. Billing and health insurance records are the most common type of patient data that is stolen. 

Kind of makes you think about your health insurance company and what is happening behind the scenes with your medical information, doesn’t it? How about medical billing practices from doctors’ offices, hospitals and medical clinics?

But there’s more.

The most common culprits for these data breaches are cloud storage for patient electronic medical records, patient data stored on unsecure databases, and patient registration on unsecure sites. Health organization employee negligence is considered one of the biggest security threats, according to the study, along with doctors and hospitals that do not encrypt patient data.

You’d think HIPAA laws would protect our medical information, especially with the onset of electronic medical records. HIPAA does not demand that hospitals and physicians use encryption.

Why not?

According to Semel Consulting’s article, HIPAA Doesn’t Require Data Encryption, it has been suggested that data encryption be a requirement for health care organizations but the medical industry has refused, claiming that it would be an unfair financial burden.


That leaves millions of patients’ private medical information/medical records vulnerable to potential hackers. Our medical records include our social security numbers, home address, and other personal information.

I don’t know about you, but I would like my medical records and personal information to be encrypted if they are stored on cloud. And that’s at the very least.

Tips to help avoid getting hacked

1. Avoid storing your own medical records or medical information on a cloud-based platform unless you are certain of the security. I still wouldn’t do it, not yet anyway. I keep hard copies of my medical records in files so I can withdraw a piece of information when I need it.

2. Avoid using health/medical apps that share your information. Read the fine print before you consider downloading an app to your smartphone or other digital device. 

3. Keep your list of medications, emergency and physician contact information in a place that is easily accessible. Consider placing the information on a Medical ID card and slip it into the slot next to your driver’s license in your wallet. I have a free, no obligation, Medical ID card on my website that you can print out. See here. 

4. You can also scan your pertinent records and keep them in a secure file on your digital device, with no connection to the internet. Consider creating a passcode in case you lose your device.

5. Each time a medical provider asks for your social security number, ask if it is necessary to provide it and if so, ask if the last four digits will suffice.

6. Ask your health insurer for a copy of your medical records (EOBs.)

7. Review your medical bills closely.

8. Visit the U.S. Department of Health & Human Services health information privacy site to view major security breaches.

This CNN Money article, Simple Tips to Avoid Getting Hacked,  offers a number of good tips to protect your privacy and online security.



14 08, 2014

Healthcare Data Mining: is your patient privacy being breached?

By | August 14th, 2014|Current Health Topics|2 Comments

The Business Insider article, Senator Warns Fitbit is a Privacy Nightmare and Could be Tracking Your Movements, reports that Senator Chuck Schumer called for federal protections to prevent companies like Fitbit from collecting, sharing and selling consumer data to health insurers, employers and others. Fitbit, like Nike+FuelBand and Jawbone, sells wearable trackers that monitor sleep, health functions and physical activity.

Senator Schumer accused FitBit and Smartphone apps of sharing users’ information and location, infringing on consumers’ privacy without their consent. A privacy nightmare is right. But in a very recent addendum to the article, FitBit responded with a denial of selling consumers’ data to third parties. They share it though, and it says so right there in the fine print.

I know. I purchased a FitBit Flex a week ago and when I read the fine print about my data being collected and shared without my permission, I returned it to the store. I didn’t want my personal behaviors shared with companies, data brokers, and others. There’s something unseemly and downright scary about that.

Which brings up the issue of healthcare data mining and how that could and may have already affected us all as patients. You may not know it but with the onset of electronic medical records, health/fitness apps and more, your data might be collected without your knowledge. According to Bloomberg’s article, Your Doctor Knows You’re Killing Yourself, some hospitals and health insurance companies are using detailed patient data to create profiles to identify those who are at high risk for getting sick and how much it would cost to treat them. Their intention, according to the article, is to intervene before a health crisis occurs.

Why are they doing this? Under Obamacare, hospitals have a big incentive to keep patients healthy because the law changes how they are paid in terms of penalties and incentives. With your health information, they can protect their financial bottom line by intervening if you are at risk.

Just like retailers have been doing for years, your credit card purchases might be tracked to see if you buy cigarettes, cancel your gym membership, fill your prescriptions, and more.

Does anyone see this is as a direct violation of privacy?

Carolinas Healthcare System, which runs more than 900 medical care centers, has begun collecting data on more than 2 million people to identify high risk patients so that doctors can intervene before they get sick. They purchased the information from data brokers who scan public records and credit card purchases.

What this could mean for you and me are surprise phone calls, letters or other forms of communication about our behaviors that affect health. Probably more.

According to Bloomberg’s article, Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick, University of Pittsburgh Medical Center’s insurance provider, purchased data on more than 2 million of its members to make predictions about which patients are more likely to to get sick, go to the ER or an urgent care center.

If patients’ health and fitness data is being collected and sold, what’s next? Health insurance companies can no longer deny coverage, but might there be incentives and penalties for patients based on their behaviors that support their health or put it at risk?

What happened to patient autonomy? Isn’t that an essential tenet of patient-centered care?  

We accept certain social media data mining. You see it every time an ad pops up after you have searched or clicked on a similar item. You’re being tracked. But somehow I thought, or naively believed, that my health information was private, confidential. HIPAA privacy laws say so. Are medical facilities and health insurers taking a sledgehammer to HIPPA by collecting patients’ data?

Personally, I value my privacy. It’s one thing if I don’t read the fine print on an app or fitness tracker and my data is shared. But if my data is collected without my knowledge and I am contacted by my physician or health insurance plan in the name of proactive or preventive healthcare, I don’t think I’d like that. It would definitely make me feel cagey, fearful of being watched somehow.  

The physician-patient relationship is crucial for quality of care, patient safety and patient satisfaction. If data becomes a major driver, then how do patients maintain a level of honesty with their providers?

Granted, we don’t have much privacy anymore, but there must be some level of confidentiality and privacy or we will, in Orwellian terms, become a society where individuals are monitored at the expense of the welfare of a free society.



22 07, 2014

More Than 1,000 Preventable Deaths a Day is Too Many: The Need to Improve Patient Safety

By | July 22nd, 2014|Current Health Topics|0 Comments

It’s a frightening statistic—400,000 patients die every year due to preventable, medical errors. This was the topic of testimony in the Subcommittee of the US Senate Committee on Health, Education, Labor and Pensions hearing, “More than 1000 Preventable Deaths a Day is too Many: The Need to Improve Patient Safety,” on July 17, 2014.

National patient safety experts testified before the subcommittee urging lawmakers to focus attention on patient safety and the need to track and reduce medical harm to patients.

The recent study by John James, PhD, a scientist and advocate whose son died due to medical errors, reports these alarming statistics. Dr. James asked lawmakers to establish a National Safety Board to investigate patient harm and suggested a standardized patient bill of rights.

Peter Pronovost, MD, PhD, senior vice president for patient safety and quality at Johns Hopkins Medicine and Ashish Jha, MD, MPH, a professor at the Harvard School of Public Health, called for the Centers for Disease Control and Prevention to track medical errors since they already collect data on hospital-acquired infections.

Tejal Ghandi, MD, MPH, president of the National Patient Safety Foundation, said that medication errors occur in up to 25 percent of patients. Ghandi also explained that diagnostic errors are also part of the problem, contributing to the number of fatal medical errors. She called for systems to be put in place to monitor patient care.

Lisa McGiffert, director of Consumers Union Safe Patient Project, asked legislators to create more meaningful public reporting of medical errors so the the general public would be more informed.

Part of the problem, experts agreed, is the need to develop measurements of patient safety efforts to produce credible data.  

Preventable, patient harm is the third leading cause of death in America, trailing behind heart disease and cancer. Let’s hope this hearing is one of many major steps toward transparency and reduction of preventable, medical errors. Medical processionals, medical facilities, patients and their families, must work together to increase patient safety for patients.

Patient safety is a team effort.

To view the Subcommittee Hearing see link here 

3 07, 2014

‘Code Black:’ A Must-See Documentary About Saving Patients in Nation’s Busiest ER

By | July 3rd, 2014|Current Health Topics|3 Comments

The new, award-winning documentary, Code Black, directed by emergency department physician Ryan McGarry, MD, reveals an insider’s view of the dynamic young doctors and nurses who struggle to save lives in an overburdened healthcare system at Los Angeles County-USC Hospital, one of the busiest emergency departments in the country.

The old L.A. County emergency department, “C-Booth,” considered the training ground for emergency medicine, is the initial focal point of the film. C-Booth captures the inspiring and the grisly of medicine in one of America’s first trauma bays. The film zeroes in on doctors and nurses crammed together in the trauma unit, shoulder to shoulder, treating patients with life-threatening situations. These scenes are vivid and alive, albeit gruesome.

The passion and commitment of these medical professionals to do whatever it takes to treat all patients is inspiring. Watching it revitalized my hope about healthcare by shining a light on what truly drives medical providers to enter the profession in the first place. This is the heart of trauma medicine in C-Booth before paperwork, data entry, checklists, HIPAA, and more, enters the provider-patient relationship.  

Flash forward to the site of the new hospital which was rebuilt in 2008. Gone are the cramped quarters with blood stains on the OR floor. For all the new elegance and flow that has replaced the frenetic energy of C-Booth, a distinct and prominent separateness between providers and between providers and patients has settled in. The new hospital allows for current requirements, digital documentation and protocols which C-Booth couldn’t accommodate. 

In a fascinating Q&A after the movie with Ryan McGarry, MD, and Jamie Eng, MD, McGarry explained to our audience that with the new requirements only 1/6 of their time is now spent seeing patients and the rest is relegated toward documentation and digital paperwork.

If doctors only have 10 minutes per patient in the ED and the rest of their time is spent entering information into computer databases, where does that leave the doctor and the patient? This is the vital question posed by Code Black. Even with the Affordable Care Act (Obamacare) there are still as many patients in the ED, if not more. 

The sticking point, however, is that patients need privacy, patient safety checklists, protocols and documentation for quality and continuity of care. If entering billing codes, filling out forms and further data entry widens the chasm between providers and patients, what do we do about it?

This excessive digital documentation is eroding physician satisfaction. In a Forbes interview, Malcolm Gladwell said, “It’s this side of medical practice that wears down even the best physicians.” And that can certainly translate to patient care.

Paperwork or documentation takes up a third of a doctor’s day, particularly with residents who must make clinical decisions with less face-to-face time with patients. With the onset of electronic medical records, this problem has eased only to yield another. “Residents may rely on notes written by other doctors instead of talking to the patients themselves,” Pauline Chen, MD, wrote in her New York Times article, Doctors and Patients, Lost in Paperwork.

There’s no easy solution to reduce the amount of documentation, staff shortages, financial cutbacks and more in hospitals like L.A. County-USC Hospital (and others,) but in Code Black, McGarry and the medical team devise a new approach by initiating care for patients in the waiting room instead of triaging cases simply based on computer data. The doctors and nurses realize that relying on code doesn’t allow them to evaluate patients face-to-face and leaves many suffering miserably in the waiting room, often for 10-18 hours at a time. 

Compassion for patients is what drives this team of medical professionals to put their heads together and come up with a strategy to overcome some of the barriers.

Code Black addresses the very pertinent issue of the provider-patient relationship and the challenges that threaten it. I hope everyone will see it. You don’t have to be involved in healthcare to enjoy it and to be moved by it. It’s a fascinating and dynamic documentary that reveals the heart of medicine and its current obstacles.



11 06, 2014

Patient Engagement: are all patients able to be active participants in care?

By | June 11th, 2014|Current Health Topics|10 Comments

Taking charge of your healthcare means taking charge of yourself as a patient and meeting the medical provider half way.  Studies show that if patients are actively involved in care and partner with providers, that they experience better health outcomes and lower costs. See Health Affairs policy brief here.   

But for patients to be active participants in care they must be willing to acquire knowledge about their diagnoses and treatment plans and learn how to navigate our complex healthcare system. This requires motivation to do basic research, to keep track of symptoms and share those symptoms with providers, to understand basic medical information, to ask questions and partner with medical providers in shared decision-making, and to take ownership of medical information.

For patients with serious illnesses and conditions, this can be a part time job. I’ve been there. I had a serious, chronic pain condition for 16 months, and towards the end of it, seeking solutions to my pain took all the energy I had. 

According to the recent WSJ article, The Health-Care Industry is Pushing Patients to Help Themselves, patients are now encouraged to engage in care, to keep track of their medical data, to seek preventive care, and to manage their conditions.

The Institute of Medicine report, Partnering with Patients to Drive Shared Decisions, Better Value, and Care Improvement, highly recommends that patients participate in care and states that the onus is on clinicians to activate patients. There are incentives for providers who show “meaningful use” of technology, including engaging patients and families in decision-making and providing them with their health records and clinical summaries.

Is this realistic to expect clinicians, who are already short on time and dealing with patient overload, to take on the responsibility to educate patients on patient engagement?

With both of my books, The Take-Charge Patient and Critical Conditions, I encourage patients and families to take active roles in care, and illustrate how to prepare for medical appointments, gather copies of pertinent medical records, create symptom diaries, ask questions and do research, create medical histories, and to form partnerships with their providers to share decision-making.

But the information requires patients to take on new roles and attitudes regarding their healthcare and their providers. This can be particularly difficult for some who are from different cultures and might be unfamiliar with the notion of collaborative relationships with physicians.

What about older seniors with multiple medical conditions and cognitive decline who are simply unable to engage in care? They need advocates. We need educational courses or seminars for their advocates and other caregivers. There are many of these seminars, thank goodness, but there must be a way to standardize the information and to reach all people.

I don’t believe that medical providers can shoulder the responsibility of giving patients and their families/caregivers a college course in navigating our healthcare system and how to advocate for themselves or others. There is a movement to reach patients directly, not only educating them on patient engagement but  empowering  them with information. My fellow advocates and I are part of that movement. The National Patient Safety Foundation states that most U.S. patients are relatively uninformed and are still passive recipients of heath care services who lack the confidence and skills necessary to engage as proactive patients. If that’s true, then we need to expand and deepen the outreach.

Patients need step-by-step directions at the ground level in their primary language, as do their advocates/caregivers. We can focus on health policy change, focus on meaningful use through providers, education and information tools through providers and advocacy organizations, which is absolutely necessary. But until patients are educated directly by an outside source, in addition to what providers offer, we’re looking at some possible long-term challenges.

There is still too much of a power imbalance between patients and physicians for information on patient engagement to be received in ways patients can adequately put to use. Patients can be intimidated by providers and some worry about creating conflict that could affect their care. How can patients integrate information provided by their physicians and nurses at a time when they are being seen for illnesses and conditions? I know I can’t. 

For example, take a sixty-five year-old man who sees his doctor, having put off a visit because he dislikes seeing doctors, and hasn’t seen one in a couple of years. He’s had abdominal pain for a few weeks and isn’t feeling well, maybe even anxious in the doctor’s office. At the time he’s given a diagnosis and possible treatment plan, he is also being educated on how he can be an active participant in his healthcare, including how to access his medical records, how to partner with his physician, and more. All this person probably wants at that moment is to feel better. But he’s being coached on patient engagement at the same time he’s being evaluated.

Patients should be educated about their role in care at a time when they are not seeing providers for diagnoses and treatment plans. This information should be presented in required courses in high schools and colleges, through government sponsored seminars in a variety of modes so everyone has access to the information. Not everyone is internet savvy. The information should be taught via live seminars to those who need it most, including people in low-income and rural populations and those who have recently gained access to healthcare.

At the very least, why can’t hospitals and healthcare organizations send out ambassadors of health, for lack of a better term, to local community groups, to offer free seminars to the patient population? This would not only provide education in a comfortable environment for patients and families, but could potentially expand their customer base.

I feel this is an urgent, unmet need the system must address. Everyone, on all sides of the table, is doing their best to change how healthcare is delivered and received. If standardized patient education were available to the masses, the goal of increased empowerment and engagement would be in reach. 

16 05, 2014

Pharmacists are Untapped Resource for Patients: what your pharmacist can do for you

By | May 16th, 2014|Current Health Topics|10 Comments

You might not think of calling your pharmacist if you have a medication question or minor medical problem. Your pharmacist can offer advice on prescription and over-the-counter medications and many offer treatment of minor injuries and ailments, prevention and wellness services, immunizations, and more.

Pharmacists’ roles are now expanding from drug dispensers to drug educators and chronic disease coaches, according to the Kaiser Health News article, Pharmacists Expand Role to Help Educate and Coach Patients

The U.S. Surgeon General recently released a report that demonstrated the value of healthcare services directed by pharmacists.

Here’s how my pharmacist helped me.

It was 5:30pm on Wednesday. I’d placed a gel ice pack on the side of my knee to treat pain that resulted from an annoying, awkward twist in a Zumba class I’d tried for the first time. The knee pain was minor, was improving, but I decided to ice it in hopes that I could get back to my regular hip-hop dance class the following morning. I made the mistake of placing the gel ice pack directly on the skin. Within 7-10 minutes my knee looked as though it had been scalded with boiling water. The skin was puffed up, angry and a deep shade of pink, with a red, fuzzy line surrounding the six-inch square. It felt hot to the touch. 

Since my primary care physician’s (PCP) office was closed, I called Arian Moini, a pharmacist I’d known for many years and whom I interviewed for my latest book, The Take-Charge Patient. I explained what had happened and texted him a photo of my knee, not thinking much about it, prepared for a suggestion to treat it with Benadryl ointment for some sort of allergic reaction to the plastic coating on the gel ice pack.

The phone rang two minutes later. It was Arian.

“Martine,” he said, “You have frostbite or technically frostnip.” 

“I have what?” It took me a couple of seconds to zero in on what Arian had said.

He continued. “I’ve looked it up. You need to run warm water on it to warm up the tissues. Don’t use a heating pad or hot water.”

“Arian, how do you get frostbite from an ice pack?”

“Frostnip,” Arian repeated. “It’s the beginning stages of frostbite.” He then explained how it occurred and suggested that I watch it carefully and see my doctor the next day. He warned that infection could set in and encouraged me to follow up with my doctor. He also suggested Advil or Tylenol for any pain.

To be honest, I didn’t really believe him at first. Who gets frostbite from an ice pack? But I did as instructed and ran warm water over the area. The swelling reduced considerably, as did the heat that had radiated from the skin. This led me to research frostbite from icepacks. Much to my surprise, I came across a number of photos that showed affected skin identical to my knee. Several credible websites confirmed the information and treatment that Arian offered.

I started thinking about the probability that many people don’t think of their pharmacist as a resource. But in fact pharmacists offer a broad spectrum of services and are easily accessible. I’m not recommending that you replace your physician with a pharmacist or to contact your pharmacist instead of your physician. This is my disclaimer.

Tips for using your pharmacist

1. Use one pharmacy to fill your prescriptions. This allows the pharmacist to catch medication errors and drug interactions. According to the JAMA article, Pharmacist Participation on Physician Rounds and Adverse Drug Events in the Intensive Care Unit, studies show that a pharmacist’s retrospective review of medication orders prevents errors. You want your pharmacist to catch errors before they happen.

2. Establish a relationship with your pharmacist. This is a lot easier with a smaller pharmacy chain or independent pharmacy, rather than a big, nation-wide chain.  

3. Review your medications with your pharmacist. Ask questions about them, such as possible side effects, interactions with other medications and supplements you might be taking, time of day to take them, if they should be taken with food, and more.

4. Generic medications come in all shapes, sizes and colors. Ask your pharmacist questions if you don’t recognize the medication you receive.

5. If you’re having trouble managing your medications, make an appointment with your pharmacist and ask him/her to help you.

6. Many pharmacists offer wellness screening programs for osteoporosis, diabetes, cholesterol, and immunizations, nutrition and diet counseling, and more. Many are also equipped to treat minor medical ailments. Ask your pharmacist if he/she provides these services.

Not every pharmacist is as knowledgeable and kind as Arian, but they are out there. You just have to look. Initiate a conversation with your pharmacist and decide if he/she is a good match for you. Ask yourself these questions: Do I feel confident in his/her expertise? Am I comfortable asking questions? Do we communicate well?

Pharmacists don’t get paid extra for phone calls or in–person consultations. Consider writing a note of thanks for extra time spent with you. If your pharmacist has gone the extra mile for you, consider a small token of appreciation. Pharmacists are generally under appreciated, as I discovered by interviewing several for my latest book.   

Even though my knee was much improved by the next day, I did, as Arian suggested, follow up with my PCP.


I welcome your comments.  

12 05, 2014

Shortened Doctor Visits: 5 tips to make the most of time with your physician

By | May 12th, 2014|Current Health Topics|5 Comments

According to the Medscape article, 15-minute visits take a toll on the doctor-patient relationship, physicians and patients alike are feeling a time crunch. 15 minutes per visit is the average, but some primary care visits are shorter. Part of the problem, the article states, is that millions of patients are now seeing doctors for the first time under the Affordable Care Act with an assortment of medical problems that have not been previously addressed.

To make matters worse, many physicians are facing greater financial pressures as reimbursements decline from health insurance plans through the health care law exchanges. Doctors are cramming in more patients to make ends meet.

15 minutes or less per office visit has been the norm for a while, as far as I know, and it has in fact crimped doctor-patient interaction. Effective communication between both parties takes time and so does the relationship that it supports. Studies show that if a patient bonds with a physician, creates a successful partnership, and the patient is an active participant in care, that there is an increase in quality of care and treatment adherence, fewer medical errors, and possibly reduced cost.

I talked with a physician today who has the luxury of spending time with patients. She asked, “How can you reduce the number of diagnostic errors if there is less time to review test results carefully, converse with patients, listen to their stories and perform exams?”

Both patients and physicians are in a bad spot. Health care reform, in some ways, is a controlling wrangler. Patients are flooding the market, there is a doctor shortage, reimbursements are declining, and health insurers are restricting choice of doctors and hospitals to keep costs down. In addition doctors are accepting fewer Medicare and Medicaid patients because of the low reimbursements and high administrative costs.  

Where does the patient-provider relationship fall in the midst of all of this? According to The Ochsner Journal, Doctor-Patient Communication-A Review, effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart of medicine and a central component in the delivery of health care. That communication cannot be conducted successfully when a doctor is looking over his/her shoulder at patients lined up in the waiting room.

Which leads some physicians to offer cash-only care and to not accept health insurance at all. This allows them more time with patients. More doctors are now skipping insurance to offer cash-only care. This kind of direct pay from patients has been accelerating as a result of the Affordable Care Act. The unfortunate piece is that many patients cannot afford cash-pay, are stuck within the confines of the 7-15 minute medical encounter, and try to make the most of it. Which is most of us, I might add.

Stanford University Hospital offers virtual doctor visits in their dermatology department as a way to save time and increase access. They claim high quality and low cost. Watch video here

What are patients to do if they have 7-15 minutes with their physicians?

Tips to make the most of your time with your doctor 

1. Come prepared for the visit. Ahead of time, create a list of questions you’d like to discuss with your doctor. This allows you to think about what you want out of the encounter. 

2. Come prepared with your top 1-3 medical concerns.

3. Come prepared with copies of pertinent medical records. There’s nothing worse than requesting your records to be sent to your doctor and arriving for your appointment only to realize that your records didn’t show up. This can be a definite time-waster. 

4. If you need a new diagnosis, create a symptom diary ahead of time and track your symptoms daily. This includes the time of day symptoms appear, what makes then worse or better, if there was a physical event that accompanied the onset of those symptoms, and when those symptoms started. Share the information with your doctor. This supports your doctor’s efforts to arrive at an accurate diagnosis.

5. Humanize yourself to the doctor. In a few seconds you can let your doctor know a little about you so you will be remembered. Several health psychologists I interviewed for my latest book, The Take-Charge Patient, suggested finding common ground with the doctor such as shared interests, children, grandchildren and activities. You’re establishing a personal connection. 

Granted, health care reform offers a number of very positive changes. But there are some issues that need to be retooled to make the new system work for both physicians and patients.


16 04, 2014

Older Patients Need Geriatric Emergency Departments

By | April 16th, 2014|Current Health Topics|2 Comments

My husband and I were seated in our family room when we heard the sirens. Since we live in a canyon, it can be difficult to pinpoint the origin of certain sounds, especially at night. I asked him, “Is that on our street?”

Consumed by the hockey game on TV, he said, “It’s probably the next street over.”

I got up and peered out the window. “I see flashing lights.” I called my friend and neighbor, Sally, who lived a few houses from us. “What’s happening down there? Is it a fire engine?”

Breathless, she said, “No, it’s the paramedics. They’re in front of Dorothy’s house.”

It took me a moment to realize that our 85-year-old neighbor was in trouble. “I’m going down there,” I said.

“Melody’s still sick. I’m stuck here. Let me know what happens.” I hung up the phone, remembering what it was like to have a sick baby with my husband out of town.

As I veered down our driveway, the flashing lights from the ambulance greeted me. The darkness of the October night closed in as I spotted Dorothy’s caregiver in the doorway of the house, her hand covering her mouth, tears streaming from her eyes.

 “Maria, what happened?” I ran to her, my nerves lit up.

Maria choked back sobs. “She not talking right, something is wrong with her. She fell down in the bedroom.”

Male voices clamored from down the hall. “Paramedics?”

Maria nodded.

Sensing her shaking, I put my arm around her. “What do you mean she isn’t talking right?” I wondered if Dorothy had suffered a stroke. She hadn’t been in good health over the last year and now used a walker, Maria always at her side.

Smoky, the gray terrier mix, barked toward the direction of Dorothy’s bedroom. Maria picked him up and held him close to her chest. “She’s not saying the right words. Something is wrong.”

And just then four men dressed in navy blue pants and brown, lace up boots, blew past us, their hands gripping the stretcher with Dorothy lying on her back, her mouth open wide as if gasping for air.

“Get out, move,” one of them yelled at us as they tore down the hallway and out the front door.

I raised my voice, my words directed toward their backs. “Where are you taking her?”

The blond one turned around and said, “Santa Monica UCLA.”

Maria and I watched the paramedics, our eyes glued to Dorothy strapped to the gurney as she was hoisted into the red and white truck.

The dog still under arm, Maria said,  “I called her son.”

“Is he coming down from Sacramento?” I hoped so. I didn’t like the idea of Dorothy being in the hospital without a family member.

“I think so.” Her voice rattled with emotion. “I have to follow the ambulance. I have to know where they’re going.” She released the dog inside, grabbed her purse and keys.

“Maria, you’re leaving Smoky?” I knew she wasn’t going to come back to Dorothy’s house that night, and maybe not the next day either.

She gave me a blank stare, tears combing her eyelashes. “I’m going to stay with Dorothy.”

“I’ll take him, we’ll keep him overnight.” We exchanged cell phone numbers and she thanked me. The expression in her eyes tore through me. “Dorothy’s going to be okay,” I said, although I wasn’t sure she was going to be okay at all. “She’s in good hands. Let’s text each other when you know something.”

I grabbed the dog, watching the taillights of the ambulance disappear into the darkness, Maria following in her Toyota.  I thought to myself, we should all be so lucky to have someone like Maria with us if we’re in our eighties and have no family in town. Dorothy’s husband of forty years had passed away several years before.

Making my way up our driveway, Smoky in my arms, I wondered how many elderly people with medical emergencies end up in the emergency department alone. Dorothy couldn’t speak but she had Maria to talk for her about the onset of symptoms, current medications, medical history, and more. Her son would probably fly down and be there by morning. But what about the older people who don’t have anyone close by and are rushed to over crowded hospitals with multiple medical conditions, on multiple medications, and are unable to communicate what is wrong?

Emergency departments (EDs) are mind numbing for anyone, not to mention for those who might be cognitively impaired. They are scary and overwhelming–the lights, the sounds and smells, the doctors and nurses scrambling to attend to more patients than they can handle.

According to Health Affairs, Transforming Emergency Care for Older Adults, hospitals are already overcrowded, strained to capacity. “Older adults seen in the ED have increasingly complex medical and psychosocial care needs.  Unlike their younger counterparts, they are more likely to have cognitive impairment, falls, depression, and sensory impairment and to be taking multiple medications.” These characteristics complicate the evaluation and management of older adults in the ED.

How is a rushed health care staff in an emergency department supposed to work quickly with an older adult who might not be able to communicate what is necessary for an accurate diagnosis and treatment plan? According to the Annals of Emergency Medicine, older patients account for up to a quarter of all ED visits and experience higher risk of adverse outcomes. 

To address those adverse outcomes and the special needs of older patients is the emergence of geriatric emergency departments. According to The John A. Hartford Foundation, there is a growing number of compassionate emergency physicians with experience in geriatrics who are trying to improve emergency care for older people. The American College of Emergency Physicians, The American Geriatrics Society and others, have created Geriatric Emergency Department Guidelines  for the growing number of geriatric EDs.

But most hospitals still don’t have them.

Geriatric emergency departments are a good step in the right direction. We need more of them. According to the American College of Emergency Physicians, the geriatric ED should be different from other health care settings, complete with non-skid flooring, guardrails and handrails, non-glare lighting, and staffed with medical professionals who are trained in geriatrics. Included in the recommendations are hearing amplification devices, magnifying glasses, clocks, signage with large lettering, and more.

Don’t our grandparents, parents and other seniors deserve emergency care tailored more specifically for their needs? If you’ve ever been with an older loved one in a hospital, you’ll agree that they do.

That night, Dorothy was admitted to a hospital that did not have a geriatric ED. But she received decent care. She was diagnosed with kidney failure and stayed there for three days. Maria was there with her every step of the way, even after the son arrived. Dorothy is back home and doing fairly well. But what happens the next time, and there will be a next time, when she has a medical emergency and she happens to be home alone? I just hope her neighbors, my husband and I included, will be around. 

11 04, 2014

Cruise Ship Docks with Sick Passengers: tips to help avoid viruses at sea.

By | April 11th, 2014|Current Health Topics|2 Comments

The Crown Princess (owned by Princess Cruises) docked at San Diego with 94 passengers and 23 crew members who are  sick with Norovirus. 117 were confined to their cabins with acute gastrointestinal symptoms, including severe vomiting and diarrhea.

Imagine being stuck on a cruise ship, unable to escape, and you and over 100 fellow passengers are vomiting and suffering with diarrhea. You’re cowering in your room, hovering near the bathroom, and you know people in neighboring cabins are doing the same thing. It’s enough to make you avoid cruise ships for good.

The Crown Princess isn’t the only cruise ship plagued by Norovirus. A Royal Caribbean cruise ship returned home early on January 20, 2014, because 700 of their crew and passengers fell ill with severe flu-like symptoms. It’s likely Norovirus was the culprit on this ship too, as the passengers were vomiting and suffering with diarrhea.

Now if that isn’t enough to keep you off of cruise ships, I don’t know what is.

CNN reported that cruise ships are floating petri dishes and are ripe for spreading illness. Outbreaks of Norovirus are the leading cause of acute gastroenteritis and occur most frequently in close quarters. And that means cruise ships, nursing homes, and dormitories.

According to the CDC, Norovirus is the most common cruise ship illness that spreads easily from person to person, through contaminated food and water and from contaminated surfaces. That covers just about everything on a cruise ship from the people preparing the meals, transmitting it to food, passengers eating with contaminated utensils, to touching any public surface on the ship and being in contact with people who are ill.


If you think these are isolated incidences, think again. So far in 2014, the CDC reports eight cruise ships infected with viruses, causing passengers to get sick, most because of Norovirus and E.coli. In 2013, eight ships were infected with Norovirus and E.coli . In 2012, sixteen ships were infected with the same.

If you’re going on a cruise (buyer beware) there are some things you can do to protect yourself:

1. Check the CDC’s Vessel Sanitation Program website and search for the cruise line  on which you’ll be traveling. See link here

2. Wash your hands frequently, which means with warm and soapy water for 20 seconds.

3. Avoid touching your mouth unless you’ve thoroughly washed your hands. This includes: eating and drinking, smoking, and brushing your teeth.

4. Avoid using the public restrooms on the ship. To keep these clean, they have to be bathed in bleach. 

5. Gel sanitizers. If you can’t wash your hands, use a gel hand sanitizer with 60% ethanol.

6. Get plenty of rest and drink a lot of water. Rest helps restore your immune system, and drinking water helps to prevent dehydration.

8. If you see someone sick (vomiting or diarrhea) leave the area.

9. If you are sick, report it to the crew and stay in your room until you are well.

You might look into portable plastic bubbles (joke) if you’re intent on taking a cruise. For germaphobes like me, I’ll take a plane or car. Hand washing can be very effective but if there is an outbreak and your fellow passengers are throwing up and heading for the bathrooms, you’ll have to confine yourself to your cabin for at least a few days. 

26 02, 2014

Are Generic Medications Safe? FDA Testing Now

By | February 26th, 2014|Current Health Topics|4 Comments

I’ve been suspect of certain generic medications for quite some time, much to the frustration of certain pharmacists and physicians who staunchly defend their quality and efficacy. Apparently, the FDA is now concerned as they have recently begun a 20 million dollar testing program on generic drugs that involves at least a dozen academic medical centers in the U.S. 

In light of the problems with a number of generic drugs and that 80 percent of prescriptions in the U.S. are for generic medications, it’s about time the FDA started a testing program on a grander scale.

Check out these facts:

2014: The U.S. imposed restrictions on India’s generic drug manufacturer, Ranbaxy, and banned imports of products made at their newest factory due to quality and safety concerns such as falsified drug test results and selling fake medicines. This is the third time Ranbaxy imports have been blocked in the U.S. since 2008. See New York Times article here  

2013: The U.S. banned imported drugs from specific Ranbaxy plants. In May of the same year the company pleaded guilty to federal drug safety violations and paid 500 million in fines and penalties. See New York Times article here 

2012: Ranbaxy exported generic Lipitor to the U.S. but the company stopped production of this drug after tiny pieces of glass were found in the tablets. See  CNN article here 

2012: The FDA recalled the generic form of Wellbutrin 300mg XL exported from Impax Laboratories and marketed by Israel-based Teva Pharmaceuticals, because it was ineffective. See the Forbes article here

At first the FDA ignored patients’ complaints about certain generics. In 2012, The People’s Pharmacy notified the FDA about hundreds of patients who registered complaints about side effects of the generic Wellbutrin 300mg XL. According to the Forbes article, A Drug Recall That Should Frighten Us All About The FDA, “The FDA brushed off The People’s Pharmacy and others that raised the issue,” and suggested that people who had a mental disease were more prone to perceived problems with a change in medication than others.

In a 2009 report, the FDA revealed that the generic Wellbutrin 300mg XL had never undergone bioequivalence testing but based on the 150mg tests, it had approved the 300mg version. The FDA recalled the generic Wellbutrin 300mg XL medication in October of 2012.

At least 40 percent of generics are made overseas and 80 percent of the active ingredients in those drugs come from foreign plants. In 2009 the FDA inspected only 11 percent of the more than 3,700 foreign facilities where drugs and active ingredients are made for the U.S. market, according to a 2010 report to Congress from the Government Accountability Office. See link here

It would appear that the U.S., at present, has little control over the generics it imports. Even as of today, the FDA’s website still states, “A generic drug is identical-or bioequivalent-to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.”

But we don’t really know that, do we?

Thank goodness for The People’s Pharmacy and others like it that take patients’ complaints seriously. Not all pharmacies do.

Case in point—a pharmacist recently told me that the breathing problems I experienced while taking a generic drug, were psychosomatic. Yes, he actually said that. This was after I’d tested the drug several times (several days on it, several days off, then repeat and repeat.) I suspect that my side effects were a result of the inactive ingredients in the generic drug. The inactive ingredients in generic drugs are not required to be the same as brand medications.

To compound the problem, The Supreme Court ruled in 2013 that makers of generic drugs could not be sued under state law for adverse reactions to their products. Makers of brand medications can be liable for inadequacies in safety warnings. This is a major loophole for pharmaceutical companies since generics are not consistently tested for efficacy and impurities. See Washington Post article here 

The FDA’s new generic drug testing program will run through 2017 and will focus on heart drugs, ADHD treatments, immunosuppressants, anti-seizure medicines, and antidepressants.

That’s a long time to wait. What are patients to do until then?

Tips for patients who experience problems with certain generic medications:

 1. If you have undesired side effects from a generic drug or suspect that it isn’t working, report it to your doctor, pharmacist and to the FDA’s MedWatch website. 

2. Ask your pharmacist or provider to switch you to a different generic.

3. Ask your doctor to do a pre-authorization for the brand form of the prescribed medication. No guarantees that your health insurance will approve it, but it’s worth a try.

4. Pay attention to your body and any symptoms if you have started a new medication. You might try creating a journal/diary of symptoms and log in the side effects, day and time, so you have a complete grasp of the problem.

5. Speak up.

More information on this topic:

Dirty Medicine, CNN Money 

Medicines Made in India Set Off Safety Worries, The New York Times 

Generic-Drug Testing Goes Widespread in U.S. FDA Effort, Bloomberg News

FDA Chief to Focus on Generics’ Safety on Visit to India, Bloomberg News


I welcome your comments!

24 02, 2014

The Sinkhole of Health Insurance

By | February 24th, 2014|Current Health Topics|5 Comments

The first time our health insurance plan was cancelled was in 2012. Anthem Blue Cross stated in a letter that our 15-year-old plan was “being phased out.” We were offered another plan, which dropped our premiums a bit but increased our out-of-pocket costs.

A year later, I was shocked when we received a letter from Anthem informing us that our newer plan was cancelled because it was not in accordance with the ACA. I dove into the Covered California website and searched for new plans. Anthem no longer offered health insurance plans that included any of our doctors or the hospital in our area. Neither did the other insurers.

What was going on? I thought Health Care Reform was supposed to increase patients’ access to care, not deny it.

I did some research. I found out that my family and I were in the Doughnut Hole of subscribers. My husband and I are self-employed and purchase individual coverage for ourselves and our daughter. I discovered that for the self-employed, health insurers are limiting doctors and hospitals on their plans to control costs. 

But then I uncovered something else. We might have had the option of keeping our 15-year-old policy that we’d had with Anthem if it were a Grandfathered Plan and if we’d had it since 2010. Wait a minute–our 15-year-old plan had been cancelled in 2012 and we’d only had our new plan for a year. Was our original plan cancelled intentionally?

Covered California didn’t offer much to us as individual purchasers of health insurance. Every single one of the plans increased our premiums and denied access to our doctors, including our primary care physician (PCP.) Blue Shield offered one plan with coverage of a hospital near our home but none of our doctors were affiliated with it. Why buy a health insurance plan that covers a hospital if your doctor doesn’t have privileges there? I wouldn’t. And neither should you. If your doctor is not affiliated with a hospital, he/she cannot take care of you there.

Eventually, I found a plan through another health insurance company that covered our PCP and our local hospital. But our new policy premiums increased over $350 a month. Ouch. Not only that but all brand medications are denied by this plan. Not covered at all, not even a portion? I’ve been taking brand Synthroid for a thyroid condition for over 25 years. My doctor wants me to stay on brand Synthroid for a reason as many doctors do with that medication. In addition, our daughter has been taking a medication for two years that does not come in generic. In the past I’d been able to reduce the cost of her medication by obtaining a discount coupon off of the drug company’s website coupled with the portion our old health insurance plan contributed.

The process of obtaining pre-authorizations for the brand of both my Synthroid and our daughter’s medication was maddening. I spent hours going back and forth between the pharmacy, doctors’ offices, and the new health insurance company because everyone had a different belief about how pre-authorizations for medications were handled. I was then informed by the pharmacy that our cost for both medications had increased. This is what we get for increased monthly premiums? I can just imagine what’s going to happen if one us is in need of emergency medical treatment and our health insurance company steps in.

Many physicians I’d interviewed for my latest book, The Take-Charge Patient, expressed a lot of frustration with health insurance companies denying treatments they’d prescribed for their patients. Most were incensed by non-medical providers interfering with treatments doctors were trained to prescribe. Some even said that health insurance companies were now dictating medical care.

Now I was dealing with this mess first hand.

My family and I are lucky—we don’t have serious illnesses or medical conditions. But consider the cancer patient in California who had been treated for stage 4 cancer and her health insurance plan was cancelled. She couldn’t find a new plan to cover the doctors who were keeping her alive.

The financial ding of health insurance doesn’t just hit individuals. According to Kaiser Health News, employers are now shifting health costs to employees, forcing them to pay more, which in essence, boils down to a pay cut. 

But wait, there’s more. According to the article in Forbes, It’s Fact, Not Anecdote, That ObamaCare is Turning Us Into a Part-Time Nation, companies all over the country are firing full time employees in favor of part time workers because they cannot afford to provide their employees with health insurance. One restaurant’s solution to this problem is to pass on the costs of providing health insurance for employees to its customers as in a percentage of the bill. At least with restaurants, we have a choice about whether to frequent them or not. 

I don’t have great answers to the challenges with the ACA for individuals and employees, but I can offer some basic tips to become better informed. The deadline for open enrollment ends March 31, 2014. If you don’t already have health insurance, better get moving.

5 tips to become better informed about your health insurance options:

1.When choosing a health care plan, ask which medical services and products the plan covers and does not cover. Ask about the deductible, co-pay, any co-insurance and other out-of- pocket expenses. You don’t want to be surprised by an unexpected medical bill. Ask questions. 

2. Find out if your doctors or hospital of choice are covered by the health insurance plan you are considering. 

3. See in-network providers. Ask each doctor, nurse, hospital, or other medical facility, if they take your health insurance plan. This includes anesthesiologists. If you need anesthesia for a procedure or surgery, ask ahead of time if they take your insurance. I’ve heard sad stories from many patients who were admitted into the hospital that was covered by their plan, only to find out later that the anesthesiologist’s fee was not covered. Ask questions.

4. Review your Explanation of Benefits (EOBs). There can be errors that affect your out-of-pocket costs.

5. Call the customer service phone number on your health insurance card or from their website and ask questions.

Become informed. That’s the only way to make better choices for you and your family.


19 01, 2014

Make Your End-of-Life Decisions Now: at some point you might not be able to

By | January 19th, 2014|Current Health Topics|6 Comments

Part of being a take-charge patient is preparing ahead of time, becoming informed so you can make wise choices, and participating in your health care. This includes end-of-life wishes. You may not want to think about this, and not many of us do, but it’s so necessary to take steps to prevent what happens to  many people in our health care system. They end up receiving care they didn’t want, didn’t anticipate, and endure prolonged suffering because of it. Not to mention the family members who are put in a position of making medical decisions in conjunction with the patient’s physician if  advance care planning documents are not in place.

Advance care planning is the most loving gift you could give to yourself and to your loved ones. I’ve completed these documents myself and have discussed my wishes with my family. Why? Because I don’t want decisions made for me if I am not able to be part of the conversation. This is my way of creating an insurance policy to avoid what I witnessed with my 82-year-old uncle, and years ago with my mother, my godmother, and countless others.

The purpose of health directives is to allow you to express your preferences concerning medical treatment in an extreme medical situation, such as when you cannot communicate or at end of life. Terminally ill patients often receive aggressive medical treatment in the hospital that can lead to needless suffering. See article here

It’s very important to discuss the following with your doctor and loved ones. Communication is key—the more your loved ones and doctor know, the easier it is for them to fulfill your wishes. Create the necessary legal documents once you are clear on what you want. Whether you want everything done to sustain your life or very little, spell it out and have a conversation with your doctor and loved ones.

Legal Documents To Create

Health Care Advance Directive: any legal document that gives instructions about your health care or appoints someone to make medical treatment decisions for you if you cannot make them for yourself.

Durable Power of Attorney: (also known as health care proxy) this legal document gives another person the legal authority to make health care decisions on your behalf if you are unable to. This person should make decisions for you as you would. Make sure that she/he is willing to be your agent and  lives close to you. Don’t choose your doctor, employee, or anyone who professionally evaluates your capacity to make decisions. Naming a health care proxy does not take away your authority. You always have the right, if you are competent, to override the decision of your proxy or to revoke your directive.

Living Will: this states your wishes about life sustaining medical treatment if you are terminally ill, permanently unconscious, or in the end stage of a fatal illness. You’ll want to ask yourself if you are comfortable with artificial feeding, mechanical ventilators, resuscitation, defibrillation, dialysis and pain management. If you do not create these documents and have not appointed a surrogate decision maker, your doctors, hospital staff and loved ones will do the best they can for you.

As a take-charge patient, wouldn’t you rather ensure that your wishes are honored at the end of life instead of leaving them up to chance? Be sure that any document you sign is consistent with your beliefs and wishes. Remember, you can change your mind at any time about any end-of-life decisions you make. Be sure a responsible adult knows where you keep your health care directive documents and provide a copy to your regular doctor. Take the documents with you if you are admitted to a hospital.

Review your wishes every year or any time your health or family status changes.

Guides and Resources to Help You

For more information, please visit





17 12, 2013

Faced with a New Diagnosis? 10 Tips to Be Your Own Best Advocate

By | December 17th, 2013|Current Health Topics|2 Comments

You’re sitting in your physician’s exam room, clothed in a gown. Your test results are in and you are about to discuss them with your doctor.  You’ve had symptoms that prompted those tests and worst-case scenarios are flooring the accelerator on your fears. Your doctor walks in and greets you with a smile and asks how you are, a question you’d be happy to answer after she discloses the results.

Your physician introduces a diagnosis that requires treatment, perhaps a few more tests or even a procedure. While your thoughts are tripping over the medical information, the image of your kids at school comes to mind along with the question, “Who will pick them up if I’m undergoing treatment?” You’re now ten steps ahead of the doctor, plotting what to do next. Should you surrender and simply let the doctor handle everything? Not exactly.  

Being a passive patient no longer works in our complex health care system. If you are a passive recipient of care, you are more likely to experience medical errors, reduced quality of care and decreased satisfaction. According to a 2011 Commonwealth Fund study, patients who take an active role in their health care find that the quality of their care increases and their care experience improves.

When facing a new diagnosis, becoming your own best advocate is about actively participating in your care and partnering with your provider. It requires getting involved, asking questions, preparing for medical encounters and becoming well informed about your diagnosis and treatment plan. It’s not that as a patient you are in the driver’s seat, but you are a significant part of the equation.

Information gathering is an important part of the process when you receive a new diagnosis. Becoming well informed about your illness, condition and treatment allows you to have more successful conversations with your providers, and with their guidance, to choose a treatment that best works for you. It also helps you to feel more in control. No one likes to feel helpless or completely dependent on medical providers. We are dependent enough on their skills and expertise.

This might sound like a monumental task if you’ve never done it before, but once familiar with the strategies, you’ll find it fairly easy. After all, this is your health we are talking about, not a car you take to the mechanic to be repaired. Your involvement matters.

Following are a few simple steps to become your own advocate when facing a new diagnosis. The more you know, the more empowered you feel.

1. Takes notes on what your physician explains about your diagnosis and proposed treatment plan. You probably won’t remember the information correctly and you’ll want to refer to it later. Also ask your doctor for pamphlets, books and preferred websites so you can begin learning. 

2. Ask for copies of tests results and for copies of other pertinent medical records that pertain to your current diagnosis. You may have to sign a form and/or pay a small fee. If you see another physician, you’ll want those records in your possession so you are in control of your information, not dependent on a doctor’s office or facility to send records that might never arrive.

3. Gather research from credible sources. If you’re comfortable on the internet, go to medical academies and medical societies as well as medical school websites. Find disease organizations and government websites. These offer the most widely accepted medical information and end in .edu, .org and .gov.  With your new diagnosis comes new responsibility—to become informed about what it is, how it affects your body and which treatments are the most successful for what ails you.

4. Get a second opinion. If you are facing a serious diagnosis or a possible surgery, obtaining an opinion from a specialist, preferably one who is board certified in that specialty and affiliated with a respected medical school is essential. Bring copies of pertinent test results with you, such as blood work, an MRI or CT scan.

5. Bring a loved one with you to your next doctor’s appointment. Whether meeting with the physician who offered you the initial diagnosis or a specialist for a second opinion, bring someone with you. That person can take notes, ask questions you haven’t thought of or have forgotten, and help you distill the medical information afterward. Not because you cannot do the job yourself, but because the emotional stress that comes from being in a doctor’s office, combined with hearing new medical information about a diagnosis, causes anxiety that interferes with memory. It does for all of us.

6. Prepare a list of questions before you meet with any doctor. This allows you to think about what you want out of the medical encounter and also reduces anxiety.

7. Take notes on paper or in your smart phone either during the visit or immediately after or ask a loved one to assist. According to The Journal of The Royal Society of Medicine , 40-80% of medical information provided by health care practitioners is forgotten immediately and almost half of that information is retained incorrectly by patients. Medical information is complex.

8. Find out if the proposed treatment is covered by your health insurance plan. This is very important. Faced with a new diagnosis, patients can feel overwhelmed and might assume that medical expenses are covered by their plan. Ask questions.

9. Ask about alternatives to the proposed treatment plan. Just because a physician recommends a certain treatment for you doesn’t mean you automatically have to go with it. Ask questions such as, “What are the alternatives to this treatment?” “What happens if I do nothing?” “What are the risks and benefits with this treatment?” Your beliefs, preferences, cultural orientation and tolerance to risk all factor in. Remember, you are part of the equation.

10. Talk to others with the same diagnosis. If you have family members, friends or colleagues with the same diagnosis, consider reaching out. They might be able to offer you support but also valuable resources and information on preferred doctors and treatments. For example, you can ask, “Who was your doctor and were you happy with his/her care?” “Which treatment did you have and was it successful?” “Can you tell me what to expect?”

There are also online patient communities with members who share your diagnosis such as PatientsLikeMe  and AskaPatient.

Healthcare Tweet chats on Twitter can also be helpful. 

Combating any sense of isolation is also important. Since I had a severe chronic pain condition for 16 months, I know. I wish I’d known about online patient communities and health care tweet chats when I was ill. It would have helped prevent some of the isolation I felt at that time.

For a list of credible research resources go to The Take Charge Patient.


I welcome your comments.  



16 12, 2013

8 Tips For a Successful Relationship With Your Doctor

By | December 16th, 2013|Current Health Topics|8 Comments

Female doctor seeing a patientAfter two business trips that took me to Palo Alto, CA and Dallas, TX with only a week at home in between, I knew that the cold I’d had for six weeks had somehow made its way into my ears. The plane flights had shoved pressure into tender ear canals and sinuses, causing pain and congestion in both.

After trying allergy medications and decongestants for six weeks, I knuckled under and saw a doctor. I hadn’t felt good for a while and it wasn’t just the ear and sinus pain but a deep down fatigue and intermittent low fever.

Seated in an exam room, noticing the smell only well-traveled doctor’s offices have, I greeted the doctor I’d known for years. Sometimes he was moody but mostly pleasant and affable. After discussing my symptoms, Dr. Y asked about my latest book, The Take-Charge Patient. We chatted about healthcare reform and its implications for physicians.

After an exam of my ears, nose and throat, Dr. Y. said he didn’t see evidence of infection and launched into a regimen of allergy medications and seven days of steroids. He explained that inflammation and allergies were the cause of my symptoms.

“The fever too?” I explained that I’d not been feeling well for a while and had been taking allergy medications and decongestants with no success. I repeated my symptoms, adding in a few more for the sake of emphasis, because after all, I wouldn’t have been in his office if I hadn’t wanted a prescription for a-n-t-i-b-i-o-t-i-c-s, the dreaded request for many doctors.

Dr. Y. grew curt and corrected me. “It’s not an infection. Maybe you picked up a virus on the plane.” He gave me detailed instructions about the steroids and allergy meds.

I explained that I was nervous about taking steroids since I’d been on them for a year and a half for a past severe, chronic pain condition. I was concerned about reduced bone density and other possible side effects.

Raising his voice he said, “Steroids naturally occur in the body. There’s nothing harmful about them. You’re worrying needlessly.”

I twisted in my seat. I didn’t want a confrontation, just “shared decision- making,” a mutually agreed upon treatment plan after a mutual discussion involving questions from both parties. That is what patient-centered care is all about, something I’d described in my book. I said quietly, “It feels like an infection.”

He leaned back on his stool in front of me, arms crossed, and scoffed. “So, you’re the doctor now?”

That irritated me. I slid into a not-so-diplomatic mode, something I rarely do with medical providers. I said, “I’m not a doctor but I do know my body. I bet I’ll be calling you in ten days with the same symptoms.” I admit, I reacted but I wasn’t feeling well, or maybe it was because I was not being respected as a patient.

Dr. Y laughed, and not a nice laugh either.

Maybe I’d crossed the line but I think he did too. He wasn’t listening to my valid concerns about taking steroids, even after I’d shared the rather alarming results from my DEXA scan and my primary care physician’s concern about loss of bone density after all the steroids I’d taken the previous year. Dr. Y might have had a valid objection to prescribing antibiotics, but he could have said what many doctors say—“Try the steroids for four days. Here’s a prescription for an antibiotic but don’t fill it unless you’re not better after the four days.” That’s giving the patient some control, some say-so when it comes to his/her body. That simple gesture implies that the doctor takes the patient seriously but also asks the patient to take the medical advice into consideration.

In the end, I was given a prescription for antibiotics and one for steroids. I took the antibiotics and a few days later I felt better than I had in six weeks. I never took the steroids.

This is an example of what you don’t want with your doctor. It shows what a poor relationship with a physician looks like, complete with unsuccessful communication and what results from that—lack of patient compliance with the proposed treatment plan. What constitutes a good relationship is a partnership, successful communication and mutual respect. Good relationships with physicians define the quality of care. According to the Oschner Journal, a good relationship with a physician increases the quality of care, increases patient safety, decreases misunderstandings and can reduce cost.

8 Tips for a successful relationship with your doctor:

  1. You feel a personal connection with your doctor. Either that starts with conversation about something you both have in common or it emerges based on a sense of kinship. You like your doctor and you sense that he/she likes you.
  2. Good communication. This is an essential component to a successful relationship with your medical provider. You and your doctor listen to one another and you feel heard. You understand what your doctor says, and if you don’t, ask him/her to repeat or redefine instructions until you do.
  3. You are comfortable asking questions. Now, this is a tough one for a lot of people because we’re afraid of offending our doctors, afraid they’ll see our quest for information as challenges to their expertise. Muster your courage because if you don’t ask those questions, you’ll be less likely to follow through with what the doctor advises and that undermines the relationship. An important part of creating a collaborative relationship with your doctor is the freedom to ask questions about your illness, disease and proposed treatment plan.
  4. You are a participant in your care. To create a collaborative relationship, you as a patient need to be involved, engaged in your health and medical care and in the relationship with your doctor. Nothing affects a doctor’s interest in you more than a patient who just doesn’t care.
  5. Mutual respect. This means that both you and your doctor respect one another as people, and respect what you both bring to the table. Your doctor brings medical expertise, and you bring your expertise with your symptoms, experience with your illness or condition and preferences about treatment plans.
  6. Mutual honesty. Honesty with your doctor goes a long way. If you’re truthful, even about embarrassing habits or symptoms, or medications you stopped taking, you are seen as a credible patient. Credibility is what you want. This enhances trust. At the same time, if you don’t trust your doctor, walk away. A relationship based on lost or absent confidence in his/her capability as a medical professional is not worth your time.
  7. Mutual discussion. The doctor’s office isn’t a classroom and you’re not the student. It’s perfectly acceptable for you to engage in a discussion with your doctor about your medical care. Maybe you’re unsure about the diagnosis. You can ask in a polite manner, “Are there any other possible diagnoses for what I have?” Discussion about your diagnosis and proposed treatment plan is important. If you don’t believe the diagnosis is correct or that the treatment plan isn’t a good match or you, discuss it by sharing information and asking questions. Give your physician a chance to work with you before you decide to walk away.
  8. Shared decision-making. A good relationship includes arriving at a mutual agreement on a treatment plan, based on your doctor’s expert medical guidance, your preferences and values and more. For example, if you aren’t comfortable with surgery and there’s a good alternative, make that known. Doctors know all too well that if you don’t get behind a treatment plan he/she has suggested, you’re not going to follow through. Better to share your concerns up front.

A successful relationship with your doctor means a collaborative one, meaning you are part of the conversation. The journal, Therapeutics and Clinical Risk Management reports partnerships and effective interpersonal communication make it possible for patients and physicians to work together to help patients follow mutually agreed upon recommendations.

9 12, 2013

10 Strategies to Combat Patient Burnout

By | December 9th, 2013|Current Health Topics|15 Comments

If you’re a patient with a chronic medical condition or serious illness, management of your symptoms and ongoing treatment might feel like a stressful job—one that you didn’t sign up for. Maybe you’re depleted or apathetic toward your care. Perhaps you’re putting off seeing your doctors or are resisting involvement in activities you used to enjoy. You might be experiencing patient burnout.

During my 16-month long, severe pain condition, I experienced burn out too. Not just because I received ten misdiagnoses from eleven physicians, or because of the 15 procedures and tests that did not lead to an accurate diagnosis. The lower abdominal pain I experienced limited my energy and ability to partake in my family and social activities, in my work and beloved dance classes. By month ten I was burned out and a bit hopeless about ever getting out of pain.

Patient burnout is a psychological condition that includes feeling physically and emotionally depleted by the ongoing maintenance of your medical condition. Part of patient burnout can also include feeling a lack of personal self-efficacy, struggling with how your condition has affected your sense of personal accomplishment. Whether you’re coming to terms with the management of your condition or chasing down treatment plans, burnout can affect anyone.

There is something you can do.

Sharon Bosch experienced patient burnout when she first received her diagnosis of multiple sclerosis (MS). During the period when she and her doctors were trying to figure out which medications worked for her, she said,

“I was trying to figure out the new normal for me.” She admitted going through a grieving period for her old self. “You have to go through the process, then you come to acceptance and realization of what you may have been able to do pre-diagnosis. Now, I do what I need to but simply do it differently.” Eventually she learned strategies to shift her attention away from her symptoms and focus on self-care and giving back to the community. She said, “I have MS but it doesn’t have me.”

Jewels Doskicz has type 1 diabetes and rheumatoid arthritis (RA). She too experienced a version of burnout or sadness when she received her diagnoses. “I am such an active person and when I learned that I could not continue with long-distance running, I was devastated.” Once she allowed herself to process the reality of her conditions, she then discovered that having a road bike would fill some of that void. Jewels also turned to volunteering in her community as a way to give back and also to transform her conditions into something positive for herself and others.

For patients with chronic illnesses or conditions that might last a lifetime, resiliency may not come easily. According to The Western Journal of Medicine, medical providers often overlook the emotional component of chronic conditions. They frequently don’t address that patients often have to adjust their lifestyles, their beliefs, and sometimes their jobs. Many patients grieve about their predicament before adjusting to it. Others can experience prolonged stress, depression and anxiety.

To combat patient burnout, Sharon became active in the MS community and founded her own organization to provide information on MS and to raise money to find a cure for the disease. She also used exercise (walking), guided imagery and listening to music to give herself mental breaks from her condition and encourage a positive state of mind. Jewels embraced yoga to reverse intermittent bouts of hopelessness and to train her mind to focus on the present, instead of worrying about what might lie ahead. She also volunteers in diabetes and RA communities and started a blog on diabetes to help others. Both women decided that they were going to be as active as they could despite the symptoms they suffered.

Many patients who have successfully battled patient burnout seem to share a similar process. They first move through a period of grieving, then arrive at acceptance of their diagnoses, and then reinvent some aspect of their lives to accommodate their conditions but also to create a new facet of their presence in the world. Many found ways to distract themselves from symptoms so they didn’t feel deluged by them. Some engaged in new forms of exercise, relaxation techniques, new employment, meditation, and activities with family and friends.

Many patients who overcome burnout share a drive to volunteer for causes related to their diseases or conditions. Giving back seems to allow them to move beyond feeling helpless to what is happening with their bodies. Many start their own support groups, and create organizations or sources of inspiration for others who share the same diseases/conditions.

In my books, The Take-Charge Patient and Critical Conditions, I write about personal control as an essential component to avoid feeling like a victim to the healthcare system. It works in a similar way with a chronic disease or condition. If you can get on top of it in whatever form works for you, you might experience an increased sense of mastery over your condition, which can help reduce the feeling that it has power over you.

I did that myself with my chronic pain condition. I enlisted a good friend as my advocate when I started experiencing burnout, and with her help, I took control of my diagnosis journey with research, organization and brainstorming my next steps. My research led me to my own diagnosis and the surgeon/hernia specialist who healed me. That in itself was empowering.

If you’re experiencing patient burnout, tapping into empowerment is key. Finding ways to take back some control can breathe life into hope and positive outlook. You can begin with small steps, whether that’s volunteering for one hour for an organization that fits your illness/condition or walking one block with a friend who has the same diagnosis and imparting what you have learned so far. It doesn’t have to be big.

Strategies to combat patient burnout:

  1. Continue being as active as you can in your personal life. It is important to maintain your identity separate from your illness/condition.
  2. Build support systems such as in-person or online support groups where you can discuss your medical condition and connect with people who truly understand. Look for groups that are solution seeking rather than groups that just air grievances. The latter is important but can also increase a sense of helplessness.
  3. Prioritize tasks and delegate to others. If you are experiencing burnout, consider asking a loved one to drive you to a doctor’s appointment or help you organize your medications, or assist with food preparation and planning.
  4. Enlist an advocate if you aren’t feeling well. Ask a loved one to go with you to medical appointments and take notes, help you prepare a list of questions, write down the answers, and serve as a second set of eyes and ears.
  5. Find things that nurture you such as massage, writing in a journal, painting or sewing. Consider listening to music and engaging in activities with family and friends. Reading, meditation and some forms of yoga can replenish the spirit. Engaging in a new activity that doesn’t focus on your condition can help expand your world beyond your diagnosis.
  6. Set up a reward system for yourself such as planning a fun activity as a reward for reaching each new goal.
  7. Set limits on how much you do for others.
  8. Seek support from a health psychologist or educator/therapist for your condition. For example, your health plan might have a list of diabetes educators or health psychologists. Find someone who understands your illness/condition, not someone you have to educate.
  9. Remember that you don’t have to be perfect. If you have a chronic medical condition or illness, keep in mind that you don’t have to do everything perfectly all the time. Try being in the moment and do your best just for today. Perfection is not realistic for anyone and it can interfere with self-confidence and hope.
  10. Take back some control. Try creating something new that relates to your disease that allows you to give to others. Whether that’s volunteering or taking what you’ve learned about your illness/condition and teaching it to someone else, do whatever you can to transform some aspect of your disease/condition into a positive contribution.

Sometimes patient burnout can lead to depression. If you feel consistent sadness, hopelessness, irritability or frustration, or feelings of worthlessness or guilt, talk to your doctor.