http://myemail.constantcontact.com/Navigator-Newsletter—September-Edition.html?soid=1103192011442&aid=C2KCCMiqSHU&share=fblike.

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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

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The article made a very clear point that evidence shows that five basic steps can prevent 1500 deaths per year, reduce catheter-related bloodstream infections by more than 30%, and save $200 million over the first 18 months.  I can see that hospital executives might not have 1500 deaths and several thousand infections on their radar screens. But since many hospitals are striving to eke out profits, I would think that a number like $200 million just might capture their attention.

The very basic five steps that would save lives and costs?  Have practitioners do the following before administering a needle/catheter into the patient’s veins:  1) Wash hands with soap; 2) Clean patient’s skin with antiseptic; 3) put sterile drapes over entire patient; 4) Wear a sterile mask, gown, hat and gloves; 5) put a sterile dressing over the catheter site.

I cannot imagine that washing hands and sterilizing the patient’s skin would be a controversial policy, but apparently so. The article goes on to state that many hospital chief executives are unaware of their institution’s bloodstream infection rates, or how easily those infections can be prevented.  It angers me that the lives and health of so many people are put at risk through neglect and ignorance.

For information on how you can help prevent infections if you or a loved one wind up in the hospital, visit the Campaign Zero website.  Campaign Zero is dedicated to patient safety and reducing medical errors.
Submitted by guest editor Debora Harvey

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A small silver Honda was trundling along at 40 mph, in traffic that was easily surging past it at 60 to 70 mph, even through a construction zone.  As I passed the car, I saw the driver – an elderly man, easily in his 80s, with white hair and beard, wearing a hat and clenching the steering wheel tightly in both hands.

My irritation immediately turned to sympathy.  I can only imagine the fear and anxiety he felt driving on a fast-moving highway, in rush-hour, through a construction zone, dealing with drivers who think they are the most important ones on the road.  That is a challenge to anyone.  For someone whose reflexes and processing time have slowed, it is an enormous challenge.

Many families have to face the issue of getting Mom or Dad, Grandma or Grandpa to stop driving when is it no longer safe for them to do so.  It is rarely a straightforward decision.  AARP has developed a Driver Safety Program that helps families evaluate a senior’s driving skills, notice key clues that there might be problems, and initiate a discussion with the driver.

The American Automobile Association also has a comprehensive site devoted to skills assessment, planning and communication.

Automedia has developed an online test for physical and mental driving capabilities.

Some states require drivers over a certain age to renew their licenses in person, and to be tested more regularly than a younger driver.  While this is often viewed as a burden by older drivers, it also helps to ensure that the older drivers still on the road do possess good driving skills.

One of the central aspects of American culture is independence.  When a person can no longer drive safely, he or she loses a huge degree of that independence.  Proper preparation and discussion can help ease the process.

Guest Editor Debora Harvey, Patient Navigator

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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

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However, sometimes people are discouraged from asking questions or doing research that would make them more comfortable with the proposed treatment plan, or even expose them to options that have not been considered.  Sadly, some care providers perceive that they are being “challenged” when a patient asks questions; others simply don’t take or make the time for a patient’s questions.

This type of situation is terribly unfortunate. It is only by communicating openly and fully with your care providers that you can make the decisions that best meet YOUR needs. Every person has the right to fully participate in all decisions regarding his or her own health care.

This legal doctrine is called the right to informed consent. The World Health Organization, the European Parliament, the American Hospital Association and many other organizations support and endorse the right of all people to make their own healthcare decisions in consultation with their caregivers.

The website  http://www.informedmedicaldecisions.org is dedicated to supporting and educating people on their rights to actively participate in medical decision making.

As a patient or caregiver, you have the right and responsibility to obtain as much information as you need to be able to commit to a course of treatment or test process. Some questions/statements that can help get the information you need include:

• Can you explain this to me?

• Where can I get more information?

• Can you write this down? Draw me a picture?

• How is this helpful to me?

• Are there any risks involved?

• Can you recommend a safe alternative?

• What are the probable side effects? What percentage of people experience these side effects?

• Does my insurance cover this treatment?

• What is the time frame for this decision – immediately, days, weeks, months?

• If I choose not to go ahead with this recommendation, what would the consequences be?

• How much time would I have to get a second opinion?

• I want to think about this before I make a decision.

• I don’t feel comfortable with this recommendation.

• Is there any else I can do or try?

By becoming actively involved in your care, you are likely to be more satisfied with your decisions.  Both patients and doctors benefit when patients are well-informed and play a significant role in deciding how they are going to treat or manage their health conditions.

Informed patients feel better about the decision process. Their decisions are more likely to match up with their preferences, values, and concerns. These patients are more likely to stick with the regimens the treatment requires, and they often end up rating their health after treatment as better.

Submitted by Debora Harvey, Patient Navigator

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One of my worst nightmares is one of my children being diagnosed with a condition that requires a bone marrow transplant.  My kids are biracial, which means that the chance of finding a match in the existing pool of registered bone marrow donors is miniscule.

According to an article in The Washington Post on Tuesday, June 1, only about 3 percent of donors listed in the National Marrow Donor Program’s “Be the Match” registry are of mixed race. Washington Post Article

People who are multiracial are one of the fastest growing demographic groups in the United States.  However, despite donor drives and new efforts to utilize social networking to increase the number of donors, they are also the most under-represented in the marrow registry.

As the number of conditions that are potentially treatable with bone marrow transplants grows, so does the demand for donors.  The first line is a family member but often, no family member is a match.  Next, doctors turn to the national registry and even international registries to find matches for critically ill patients.  For single race patients, the chances are slim.  For those of mixed race, those chances are virtually non-existent.

I have been registered with the National Marrow Donor Program since 1991.  I have been called twice with the news that I was a potential match for a critically ill individual.  Both times I unquestioningly proceeded with the next level of screening necessary to determine a true match.  Sadly, both times, the potential recipient died before it was possible to schedule a donation.  In some ways I felt the loss of their lives deeply.  Lives that were lost that maybe, just maybe, a few ounces of my marrow cells could have had a role in saving.

For more information on registering to be a donor, click on  http:/www.marrow.org

Guest editor Debora Harvey, Patient Navigator

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We’ve all seen the endless television commercials in which sad and dejected people suddenly start looking happy after taking the particular pill being advertised.  However, it’s just not that simple.  Depression or clinical depression is a mood disorder that comes in different forms.  Depression affects 1 out of 5 women and 1 out of 10 men.   It is more than just feeling sad or getting the “blues.” Depression lasts for two weeks or more with many symptoms.

Major Depression Disorder has a variety of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy activities they previously enjoyed.  An episode of this depression can occur only once in a lifetime, but often usually recurs throughout life.

Dysthymia is a long term but less severe type of depression. The symptoms may not disable a person but can prevent them from functioning normally or feeling well.

Psychotic Depression occurs when a severe depressive illness also has some kind of psychosis. This psychosis can include a break with reality, hallucinations, or delusions.

Postpartum Depression is common in new mothers when they develop a major depressive episode within one month after giving birth.  It is estimated that 10 to 15% of women experience postpartum depression, as do some new fathers.  It is a serious illness that needs fast and effective treatment.

Seasonal Affective Disorder is the onset of a depressive episode during the winter months caused by lack of natural sunshine. Spring and summer usually alleviate the symptoms as well as light therapy.

Symptoms of depression disorder include persistent sad, anxious, or empty mood, sleeping too much or too little, and changes in appetite and weight.  In addition, there is loss of pleasure and interest in once enjoyable activities, including sex, persistent physical symptoms, restlessness, and irritability.  Difficulty concentrating, remembering, or making decisions, fatigue, loss of energy, feelings of guilt, hopelessness, or worthlessness and thoughts of suicide or death may also be present.

Many things contribute to depression.  Biological reasons seem to be one of the major causes. Depression can be caused by too little or too much of certain brain chemicals called neurotransmitters, such as Serotonin and Norepinephrine. Changes in these chemicals may cause or contribute to a major depressive episode.

Cognitive functioning may also contribute to depression.  Negative thinking patterns and low self-esteem more than likely lead to depression. Gender may play a role as well, with women experiencing a rate of depression nearly twice as that of men.  Though reasons are unclear, depression may be caused by hormonal changes and stress in women.

Depression may also be caused by side effects from medication or conditions of other illnesses such as heart disease or cancer.  Genetics may also play a part in depression with a family history of mental illness as well as situational causes such as divorce, financial problems, and death of a loved one.  Drugs and alcohol can also cause depression.

Depression, even the most severe cases, is highly treatable. First, medications or medical conditions should be ruled out.  Once that is done, a psychological evaluation can pinpoint the disorder.

Medication is often used in the treatment of depression. SSRIs (selective serotonin reuptake inhibitors) such as Celexa, Lexapro, and Zoloft are very effective in treating depression.  SNRIs (serotonin and norepinephrine reuptake inhibitors) such as Effexor or Cymbalta are similar to SSRIs and very helpful in treatment.  These medications often take three to four weeks to begin working and are to be used regularly for the therapeutic effects to occur.  For continued control of depression, medication must be used even if one is feeling better.  There may be side effects with some medications that can be managed with other medication or by trying a concurrent, antidepressant.

Therapy can also be a good treatment, along with medication, for depression. Talk therapy with a psychiatrist, psychologist, or therapist can help with understanding depression and its effects. It can work toward positive changes in outlook and practical changes to reduce stress. In, addition, group therapy may also work well. Others with depression can share their experiences, challenges, and ways of coping. It can be a strong base of support for one suffering with depression, with encouraging and positive experiences.

Depression is a serious mental illness that can be controlled with a doctor’s care and medication. Depression does not have to rule your life. With information and care, depression can be alleviated enough to help one function well.    If you think you may be depressed, please see a medicalprofessional.

For more information, please visit the National Institute of Mental Health athttp://www.nimh.nih.gov/index.shtml

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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

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A few weeks ago, during my son’s routine 12-month check-up, his doctor and I were making small talk and it came up that I am a Cancer Information Specialist trained by the NCI.

My son’s doctor, a lovely woman whom we’ve seen before turned to me and said “The NCI?” to which I replied “The National Cancer Institute” and her reply was “What is that, some sort of Government agency?”

I was blown away.   My jaw practically dropped to the floor.   Maybe it’s naiveté, but I just assumed that all doctors, regardless of their chosen field of specialization, would have at least heard of the National Cancer Institute (www.cancer.gov)   Am I wrong?  I understand that doctors choose a special track or focus and that they cannot be expected to be fully familiar with each facet of the medical world, but aren’t all aspiring doctors introduced to each field of medicine while in medical school?

Even if aspiring doctors aren’t exposed to all fields of medicine in their education, wouldn’t someone in the medical world, particularly a doctor, know that the National Cancer Institute, created in 1937, at least existed?

I left the office a little perplexed.   If this doctor hadn’t heard of one of the largest medical institutions in the world, should I let her be in charge of my son’s health and well being?  Is this a big deal?   Am I making too much of this?   I would love to hear from others about this topic. Please comment and tell me your thoughts.

Guest Editor, Heather Matthews – Patient Navigator LLC Cancer Information Specialist

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