The September edition of Navigator News includes articles on: Understanding Palliative Care; The Fine Print of your Insurance Policy; and Food Science Part 1. We welcome your feedback!
A recent survey revealed that 91 percent of physicians surveyed practice defensive medicine – they regularly order more tests and perform more procedures than are medically necessary in order to protect themselves from the possibility of being sued for medical malpractice.
This survey, by a team of researchers from Mount Sinai School of Medicine, confirms that the fear of being sued is very real and pervasive throughout the entire spectrum of medical practice.
In addition, those surveyed responded that the “overwhelming majority of physicians support tort reform to decrease malpractice lawsuits and that unnecessary testing, a contributor to rising healthcare costs, will not decrease without it.”
Defensive medicine is expensive, inconvenient to both doctor and patient, compromises the relationship between provider and patient, and has no basis in evidence-based medical practice.
Unfortunately, the practice of defensive medicine decreases patient access to health care, and increases costs of healthcare for everyone. Some patients are left in the lurch as physicians avoid the sickest patients, or those requiring higher-risk procedures, in order to reduce their exposure to malpractice suits.
A 2008 study by the Massachusetts Medical Society found that 83% of its physicians practiced defensive medicine at a cost of more than $1.4 billion annually in that state alone.
To me, $1.4 billion in one state translates at a conservative estimate to at least $30 billion annually throughout the country.
I find the dollar cost of the practice of defensive medicine disturbing. I find the cost of the doctor-patient relationship, in which the physician views every patient as a potential lawsuit, rather than a person in need of healing, frightening and discouraging.
More medicine is not better medicine. Evidence-based, patient-centered medicine is better medicine.
Submitted by guest editor Debora Harvey
I have been reading a book called The Strong Women’s Guide to Total Health. I like this book, not only for its great title, but because it is easy to read and understand, with sensible health information.
As I was reading the section titled “Standing Strong; Our Living Framework,” I began to think about mothers and grandmothers. When I was a child, my maternal grandmother seemed to be a giant – tall and strong. By her 90th birthday, she had lost more than 6 inches in height and had very little muscle tone. She had absolutely no interest in exercise, satisfied that walking her dog and weeding her garden were quite enough.
My 87 year-old mother-in-law is now shorter than my 10-year old son. She, too, has lost a substantial amount of height, strength and stamina. Whenever we mention any sort of exercise, or nutritional advice, she nods politely, but I can tell she is mentally brushing us off.
On the other hand, my mother tries to eat a diet that promotes bone strength. I take 1200 mg of calcium/day, and do weight bearing exercise. My 13-year old daughter grumbles, but agrees to take her calcium and vitamin D supplements most of the time. What will this mean as we age?
Well, the hope is that our bones, muscles and connective tissue will be strong enough to sustain us through 9, 10 or more decades of high-quality life. Building strong bones at an early age – during childhood and adolescence – is our best defense against developing osteoporosis later in life. But no matter how old you are, it is never too late to start taking care of your bones.
Some factors that affect your bone health, such as age, gender and genes, are beyond your control. However, lifestyle choices, especially diet and physical activity, are responsible for up to 50% of bone mass and structure. Getting enough Calcium and Vitamin D in your diet, and some sort of weight bearing physical activity are highly recommended for people of all ages.
More information about prevention of osteoporosis and age-related bone degeneration can be found at the The National Osteoporosis Foundation website.
You can also visit the excellent women’s health site from the Department of Health and Human Services.
Guest Editor, Debora Harvey, Patient Navigator
Lines of pain etched into her face. Eyes too bright, revealing the agony inside. Jaw tight, skin stretched taut. I never really thought about the descriptions of people in pain that I have read in newspaper stories, magazine articles, online sites, novels and non-fiction books, other than to appreciate the evocative images. However, it has struck me, that not only are those phrases highly accurate, but they only reveal a small piece of what a person shows externally when they are living with chronic pain.
There are many physical conditions that result in chronic, intense pain. People with these conditions have to manage to live and try to function in varying degrees of agony, sometimes 24 hours a day, 7 days a week. This is an entirely different situation than the pain that the majority of the population may encounter, say, from a broken bone, childbirth, or dental work.
To add insult to injury, many people suffering from intense chronic pain are told that it is “all in their head” and that they should see a psychologist. Or they are referred to a pain clinic, whose doctors are more interested in administering the latest drug of the month, likely not covered by insurance, than in listening to the patient and understanding the nature of his or her specific condition.
Chronic pain itself, whatever the underlying cause, is a killer. The effect of ongoing intense pain on the mind and body actually does result in an earlier death. http://updates.pain-topics.org/2010/04/severe-chronic-pain-is-killer-study.html
This evidence shows that effective treatment of ongoing severe pain is essential for any sort of positive quality of life.
Thankfully, we at Patient Navigator have unearthed several palliative care physicians who are not only invested in alleviating the patients’ pain, but actually listen to the patient, working with them to improve their quality of life, while coordinating care with other members of the medical care team to treat the underlying cause. I have seen patients weep in gratitude that a medical professional finally takes them seriously. I have seen their energy levels increase, and their lives turn around, when they finally find the right balance of medications for pain management.
I have seen their eyes turn bright with smiles, without the pain shadowing behind.
For more information on managing chronic pain, see:
Pain Topics: http://pain-topics.org/
American Chronic Pain Association: www.theacpa.org
For more information on Palliative care: http://www.getpalliativecare.org/ and http://www.nlm.nih.gov/medlineplus/palliativecare.html on Medline.
Submitted by Patient Navigator Debora Harvey
The Internet is an amazing tool for people researching health conditions, possible treatment options or medical specialists. An unlimited amount of information is available at the click of a mouse. This is good, right?
Unfortunately, the reality is a double-edged sword. Yes, the Internet lets people become well informed, but it has can also foster “cyberchondria” and “analysis paralysis.”
I now see my Great Aunt Frieda in a whole new light. I’m glad that she lived before the Information Revolution. You see, Auntie F, as we called her, was a hypochondriac. She constantly visited her doctor for a multitude of problems. It was easy then because doctors could spend more time with patients and it cost less. So her doctor would listen to her, reassure her that she was not dying of the symptom of the week, and see her again in a week or two to hear about her newest issue. She lived, in nearly perfect health, until a peaceful death at age 95.
The 21st century gives us a new twist to this story. “Cyberchondriacs” spend hours at the computer screen, typing in symptoms or fears, wading through the results, both accurate and inaccurate, and convincing themselves they have a certain condition. Often, they will print out reams of documentation and present themselves to their doctors, having already diagnosed their “condition” and determined a course of treatment. To make matters worse, bogus information may appear as genuine evidence-based medicine and is often flanked by marketing ploys offering miraculous treatments
In a May 2002 research report, the Pew Internet & American Life Project (www.pewinternet.org) called them “health-seekers.” “About 6 million Americans go online for medical advice on a typical day,” said Pew in its Vital Decisions report. “That means more people go online for medical advice on any given day than actually visit health professionals (on a given day),” Pew said, comparing the 6 million estimate figures to an unspecified, but lower number provided by the American Medical Association.
What is the cost of cyberchondria? It is estimated in the millions of dollars and rising every year due to unnecessary visits to the doctor’s office or emergency room, un-needed and possibly invasive tests.
Online medical information is wonderfully helpful and useful in many situations. But, like anything else, moderation is the key. Choosing sources wisely, using good sense to edit the results, and getting OFF of the computer when it all becomes too much are important keys to successful use of online health information. To learn more about evaluating health information on the Internet, visit http://tinyurl.com/Evaluate-Info-On-Internet
Submitted by Guest Editor Debora Harvey, Patient Navigator LLC
The March 4, 2010 New York Times included the following article which discussed the emerging profession of health navigators and patient advocates. Take a look. http://tinyurl.com/healthnavigatorNYT
In honor of Valentine’s Day, I thought I’d write about one of my favorite guilty pleasures, CHOCOLATE! Chocolate can be good for you. Sure, a chocolate bar loaded with caramel and/or nougat carries few health benefits, but dark chocolate has been found to have many heart-healthy benefits that are otherwise absent in milk or white chocolates.
A healthy heart allows your body to work properly by supplying it with the right amount of blood, flowing at the correct rate. A diseased or injured heart, however, has to work overtime to allow your body to function well.
Here’s where the dark chocolate comes in.
Research has shown that dark chocolate improves blood vessel functioning, thus lowering blood pressure, taking stress off your heart and helping your blood circulate more efficiently. Dark chocolate also has antioxidant qualities, which come from flavonoids found in cocoa. Flavonoids are naturally occurring plant based compounds that repair and protect plants from harmful environmental substances. When consumed by people, flavonoids provide an antioxidant that can repair cell damage from toxic substances, such as cigarette smoke. Due to its antioxidant nature and cancer prevention possibilities, researchers agree that cocoa needs to be further studied.
While this is certainly welcome news, remember, everything in moderation. Eating your required daily intake of fruits and vegetables remains the number one way to stay healthy, but indulging on a piece or two of dark chocolate a week is a good thing! So on Valentine’s Day, nothing says “I love you” like some delicious, dark chocolate.
For more information on dark chocolate and your heart, please visit;
http://my.clevelandclinic.org/heart/prevention/nutrition/chocolate.aspx
Submitted by Heather Matthews, Cancer Research Specialist at Patient Navigator LLC.
A caregiver is someone who takes you to your doctor’s appointments, drives you to and from treatment, helps with activities of daily living, listens to you and lends a shoulder to cry on. A diagnosis such as cancer can shake the foundation of any family and caregivers play a vital role for loved ones diagnosed with a serious illness. Not only is the patient required to drop everything to focus on their treatment plan; caregivers must also, to some extent, put their life on hold to fill an important role.
All too often, however, caregivers’ needs go unmet and the burden they share goes unrecognized. Doctors, nurses, family and friends make sure the patient comes first, and rightfully so. However, caregivers also suffer as they watch a loved one battle illness. Caregivers can feel as though they’re not doing enough to make their loved one comfortable or happy, despite their heroic efforts. Caregivers can also receive the brunt of a patient’s anger, since typically this role is filled by a person close to the patient.
The Journal of General Internal Medicine recently released ethical guidelines addressing patient, physician, and caregiver relationships. The medical community is increasingly respecting the role of caregivers and offering guidance on how to develop that relationship. The guidelines aim to focus on a family-centered approach to treatment thereby decreasing the caregivers’ susceptibility to stress-related illness. One such recommendation states that physicians should be more accessible and allow for more effective communication not only to the patient but also to the caregivers.
Remember that it’s important for caregivers to be mindful of their own health and needs. Take time out to go for a walk, rest, go to a movie. Many communities offer respite services to give you some time away. It can also be very helpful to seek out a caregivers support group in your local community. Strength is gained when experiences are shared.
For more information and resources for caregivers, please visit the following sites:
http://www.cancer.gov/cancertopics/coping/familyfriends – National Cancer Institute
http://www.cancer.net/patient/Coping/Caregiving American Society of Clinical Oncology
http://www.cfad.org/ Caring from a Distance
http://www.caregiver.org/caregiver/jsp/home.jsp Family Caregiver Alliance
Submitted by Heather Matthews, Patient Navigator Cancer Research Specialist
Many of you reading this blog have experienced some type of difficult health situation, for yourselves, a friend or family member. It’s also what makes so many of us passionate about helping others through their illness. It’s why Patient Navigator exists.
Since it’s the New Year, most people take some type of inventory of their lives and resolve to make changes. But truly, taking care for our health should be the most important thing we do – more important than money, a promotion or material goods. Because without health, we feel powerless.
I don’t need to restate the recommendations we’ve all heard a thousand times about healthy diet and exercise. We know what we need to do. So let’s reflect today on our health and the gift that it is, the miracle that is the human body. If you are suffering, see what steps you can take to improve your situation. Your body is meant to work so beautifully; if you’re hurting it, please resolve to try harder to nurture and respect your health.
I went out and bought a teapot and some wonderful teas today. I resolve to make myself a pot of green tea every evening at about 5:00. Please think of one good thing you can do or change. Once you’ve done it, the rest will come more easily because you will feel your body thanking you. Here’s to a New Year 2010 of good health and serenity.
We were recently on a radio show! Patricia Grace of Aging with Grace interviewed Elisabeth Russell October 26. If you are interested in hearing the types of things Patient Navigator can do to help you or a loved one, please listen in. We welcome your feedback.
