Archive for the ‘Find Doctors’ Category

A Fear Of Sickness Or A Sickness Of Fear?

Posted on September 17th, 2015 by karen

Doctor Transparency

by Kim Keller

Dr. Leana Wen’s interest in bringing transparency to the medical profession began back in 2003, when she was still a medical student.

Leana’s mom, Sandy, had been diagnosed with stage IV breast cancer, which had already spread to her lungs, her bones and her brain. During her third round of chemo, Sandy happened to misplace her address book, so she went online to look up her oncologist’s phone number, and that’s when she discovered that her oncologist was also a highly paid speaker for the drug company that manufactured her prescribed chemo regimen.

Sandy called her daughter in a panic. It made her question her treatment plan. Is the chemo regimen right for me, she wondered? Or is it being prescribed because of my doctor’s financial relationship with this particular drug company?

Leana and her mother weren’t sure what to believe, but the answer was almost secondary. “When it comes to medicine,” Dr. Wen explained, “having that trust is a must, and when that trust is gone, then all that’s left is fear.”

Wen has enjoyed a long and varied career, serving in many capacities, both as a physician and public health official, including, most recently, as the Commissioner of Public Health in Baltimore, MD. And in all her various positions, Wen has discovered that many doctors share that same fear she described above. The absence of trust is by no means restricted to the patient population.

Indeed, there was an incident that left a great impression on Wen during her medical school years. She was caring for a 19-year old boy in a coma, whose body had undergone enormous trauma when he was hit by an SUV. The young man’s parents had immediately flown in from Seattle, traveling some 2,000 miles to be with their son in the hospital. The parents obviously wanted to receive as much information from the medical team as possible. In fact, they asked to be present when the medical team was doing rounds in order to help the parents understand exactly what was happening with their comatose son.

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If Only There Was A Second Time Around

Posted on July 9th, 2015 by karen

If Only There Was A Second Time Around

by Kim Keller

As another anniversary of our father’s passing — July 16th, to be exact — approaches, my sister Karen and I find ourselves once again filled with regret for all the lessons learned, far too late in life, about how to help someone you love through serious illness.

Dad’s health issues lingered for quite some time, but during the last year of his life, he deteriorated at a tumultuous pace. It was a painful ordeal, and if it were possible to go back in time, Karen and I would do many things differently.

We would have more actively:

  1. Insisted that our father seek better medical care earlier in his illness. The critical lesson here: sometimes you just have to travel farther for better hospitals and doctors. Dad made his choices based primarily on location, and while we often questioned the quality of his doctors and their related facilities, we weren’t comfortable pushing this point with him, until it was far too late in the game. Given what we now know, we would have kept researching hospitals in the region until we found a teaching hospital with MAGNET status. Teaching hospitals generally attract higher caliber doctors, and a MAGNET designation indicates an impressive level of quality care bestowed upon patients by the nursing staff. Naturally, there are great hospitals that are not teaching facilities, as well as many without MAGNET status, but it’s an excellent place to start.
  2. Focused on how Dad could reduce the amount of medications he was taking. He had lots of specialists, especially as his health unraveled, and each doctor added a new prescription or two. Not enough attention was paid to the possible side effects and adverse interactions caused by combining so many medications. In fact, rather than scrutinizing the burgeoning list of drugs that were being pushed at our father, each new medical issue that cropped up heralded another new prescription. Given what we know now, we would have discussed the medication list with all the various specialists, starting with these five questions: (1) Are any of Dad’s symptoms a possible side effect of another medication? (2) What are the potential side effects of each drug? (3) Is this drug safe and/or effective for someone over 65? (4) Are there any issues to watch out for when this drug interacts with Dad’s other current medications? (5) Is there any harm in changing Dad’s diet and/or exercise regimen rather than prescribing another new medication? And to help us with our own research, we would have used MediGuard.com, which is a great tool for fleshing out medication problems.
  3. Talked with our father about end-of-life issues. Dad already had a living will in place, so we thought we were covered in this important area, but we were wrong. We soon discovered that many common scenarios needing to be fully vetted are not handled by the average living will. For example, do you continue with aggressive treatments when they can’t cure you but can only sustain a bedridden life? Not an easy question to discuss, and we certainly never discussed this as a family, but at a certain point late in the illness, Dad was no longer able to give his input, and continuing treatments no longer held any promise of recovery. We decided to maintain the full-on treatments, but we’ve never been sure this was what Dad wanted. If we’d known back then about the critical importance of a wide-ranging end-of-life discussion, we would have used www.agingwithdignity.com. It’s an important resource that walks you through the fundamental questions that every family needs to consider.
  4. Established ourselves as coordinators for keeping track of all communication between and amongst the various medical personnel and caregivers attending to Dad. Karen and I just didn’t understand, at least not at first, that someone had to pull together all the various pieces of information relating to Dad’s care, from medication mandates and treatment instructions to exercise orders and diet alterations. Counting on the medical teams to coordinate and communicate was not realistic. We eventually learned to keep track of everything and to communicate everything. There was nothing too big or too small. Here are some of our charts and checklists.
  5. Created a support team around us to help us anticipate needs, develop a plan, make better decisions, and clue us in on available resources and tools. Frankly, back then we didn’t even realize we needed a support team, other than our father’s medical attendants. Dad had been sick for so long that we never would have believed we were facing his final year. Without a support team, we spent way too much time being reactive, putting out fires, floundering with decision-making. If we could do it all over again, without the pain and torture that Dad surely experienced, we would’ve reached out to people who had been down this path before. There are many places to start building a team: in-home care agencies, for example. Or local religious organizations, many of which have outreach programs, geriatric care managers, and senior centers. When we finally did build our team, we were relieved and finally confident that we were making sound decisions. We didn’t understand at that point how close we were to the end, but we were at least able to spend our time in a far more important and valuable way: loving our father and enjoying every last minute with him.
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How To Heal Medicine

Posted on May 28th, 2013 by karen

Checklist promote safety

by Kim Keller

Sometimes things are not as complicated as they may seem to be. Yet the issues surrounding healthcare seem pretty complicated to me.

That’s why it was both interesting and refreshing to hear Atul Gawande — surgeon, Harvard professor, writer and journalist — eloquently discuss how we can “heal medicine” in his inspiring and hopeful TED Talk.

Gawande believes our country’s conversation about healthcare has turned into a political debate that focuses on who’s at fault — the government or the insurance companies. But “it’s deeper than all of that,” he explains. “The cause of our troubles is actually the complexity that science has given us.”

By which he means, we have amazing technologies and medicines and doctors, but what we don’t have is a system to pull it all together.

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How To Get Your Parent To Change Doctors

Posted on May 10th, 2012 by karen


by Kim Keller

This is a question we get asked all the time.  Unfortunately, there is no easy answer.  We urged our dad for years to change his doctors, but the suggestion was always met with resistance.

Why?

Probably several reasons:  One, our dad figured all doctors were basically capable, and two, he didn’t want to have to start all over again.  A new doctor means explaining your health story all over again, and, even more daunting, MORE TESTS.  More poking, more prodding, more needles.  Also, there was probably some sense of loyalty — if our dad liked a doctor, he would cut him or her some slack.  In his mind, friendliness and a medical degree equaled competence.

But if you’re sure a change is necessary, stick to your guns.  Even if your parents are reluctant to make a move, don’t give in.  It’s just too important that your parents have the best possible treatment.  However, on the other hand, it is also important to keep your parents involved in their own decision-making, so you have to walk a thin line between coercion and cooperation.

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Every Medical Team Needs A Quarterback

Posted on April 16th, 2012 by kim

Establish A Leader Among Doctors www.incareofdad.com

by Kim Keller

Like many seniors, our dad had a large group of specialists treating him.  Each specialist, working independently, prescribed medications.  But none of the specialists were in communication with each other and we found that no one was really in charge.  We desperately needed someone to oversee our dad’s care.  We needed one doctor to act as the “quarterback.”

The quarterback, in this context, is the one doctor to whom all the specialists report.  One doctor to gather and examine the results of all tests, diagnoses, procedures, recommendations, and medications.  One doctor to critically evaluate the list of drugs being administered, challenging why each is necessary and how they all work together.  This is the doctor who focuses on the overall health plan, instead of just a segment as a specialist does.

Typically, this would be the responsibility of a primary care physician.  If the primary care physician is not fulfilling this role, you might first have a conference with him or her and explain your need for a medical-team leader.  If it still feels as though the situation won’t work, you definitely need to look to another doctor.

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Sometimes No Treatment Is The Best Treatment

Posted on January 19th, 2012 by kim

hysterectomy cartoon

by Kim Keller

Did you ever wonder if all of the tests, treatments and medications that doctors order are really necessary?  Karen and I started wondering about this during our dad’s illness, and we became even more convinced it was true when our mom had a stroke a few years ago.

Naturally my curiosity was piqued when I noticed the cover story in a Newsweek from a few months ago (August 14, 2011), entitled “One Word That Will Save Your Life: No!”  Research by the author, Sharon Begley, brings to light the fact that many low-risk patients with light symptoms at best, some with no symptoms at all, suffer more harm than good from various types of tests, procedures and medications.

“There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and the editor of the American Medical Associations’s Archives of Internal Medicine.  “Less is more,” she explains.

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How To Help Your Doctor With A Diagnosis

Posted on January 11th, 2012 by karen

How Doctors Think

by Karen Keller Capuciati

I learned quite a bit from the non-fiction bestseller, How Doctors Think, by Jerome Groopman, M.D.  I highly recommend this engaging and very readable book to anyone who ever wondered, “What the hell is that doctor thinking?”

As a physician, Jerome Groopman became curious about what goes on in the minds of doctors when they’re working with their patients, especially in those cases where there’s no obvious diagnosis.  What’s behind the cognitive process that leads a doctor to a diagnosis and treatment plan?  Through fascinating case studies, Groopman brings the reader along the decision-making process to explain how doctors reach their conclusions, and why the same doctor making a life-saving diagnosis on Tuesday can make a life-threatening error on Wednesday.

Experts studying misguided care have concluded that the “majority of errors are due to flaws in physician thinking, not technical mistakes.  In one study… some 80 percent [of dangerous misdiagnoses] could be accounted for by a cascade of cognitive errors.”  Indeed, “another study of 100 misdiagnoses showed that doctors didn’t stumble because of inadequate medical knowledge; rather, they missed diagnoses because they fell into cognitive traps.”

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How To Prepare For Each Doctor Visit

Posted on June 1st, 2011 by kim


by Kim Keller

If your situation is anything like ours was, after the doctor left the room we often wished we had asked a certain important question, or we were still confused about some aspect of the situation, and when our dad was in the hospital, we had basically no idea when we would see that doctor again.

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Changing Doctors

Posted on May 18th, 2011 by kim

by Kim Keller

I remember this funny conversation I had with my mother about changing doctors.  This was after Dad died and before Mom’s stroke.  I said, “Mom, you need to find a new doctor because this guy you have now is just not paying attention to you.”

She looked at me askance.

“I know you hate the idea of starting over with someone new,” I continued on, “but remember what we learned when Dad was so sick? You need to have good doctors in place before you really need them.”

My mother was unmoved.  “Kim, I really like my doctor.  And I don’t want to make a change.”

“Okay,” I said, “tell me what you like about him?”

“Well,” she began, “whenever something’s wrong, he just calls in a prescription for me, and he doesn’t make me go into his office to see him.”

I took this in for a minute.  Then I looked at her with disbelief.  I’m wondering, did I hear that right?  “MOM, DID YOU HEAR WHAT YOU JUST SAID?” I asked, astonished. “That’s exactly what I’m talking about!  That’s outrageous!”

She gave me a guilty look.  “That sounded terrible, didn’t it?”

So she changed doctors after that conversation.  Unfortunately, the next doctor we picked seemed to be sleepwalking through her care as well.  But, finally, after her stroke, we asked our favorite nurse for a recommendation, and Mom agreed to give the new doctor a try.  Now we love Mom’s new physician — she’s smart, she listens, she’s engaged, she communicates, and — my personal favorite accolade — she focuses on Mom’s medications.  What a difference!  Mom’s glad now that she made the change.

For more information about changing doctors, see our section on How To Find Doctors.

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