Cell 2 Soul: The Humane Health Care Blog

Ask Patients, "What Matters to You?"

A brief article, Ask patients What matters to you?” rather than “What’s the matter? by Sosena Kebede in the British Medical Journal is well worth reading.

“A lot of what matters to our patients is outside of what we can offer them as physicians, and our success in meeting their needs demands our ability to integrate our care with their lives outside of our hospitals and offices.” As an example, the Dr. Kebede recently “asked one of her patients what mattered to her, after attempted pain control did not alleviate her distress. In between tears, my patient told me about her hobbies and family. This gave a new perspective on patient care.”

For full article: Download What Matters by Kebede

photo from The Guardian, August 2015

Open Notes: What and Why?

patients and providers on the same page

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss those notes with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes.

OpenNotes is a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.

Evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

Smart Patients

 

"Smart Patients is an online community for motivated patients and their families and friends. You can learn at your own level about scientific developments related to your condition, share your questions and concerns with other members, and use what you learn in the context of your own life.

We believe patients are the most underutilized resource in healthcare. We've watched patients become experts in their conditions — and we see that their knowledge improves the care they receive. With the right tools, you and other patients can do the same."

This is an interesting and valuable tool for motivated patients, care-givers and health care providers.

Also see: Roni Zeiger's TED Talk in Smart Patients

10 Commandments of Patient-Centered Care

These commandments appeared in the British Journal of General Practice.  While they refer mostly to therapeutics, they are applicable to most doctor-patient interactions.  We have edited the BJGP article as it was too verbose. Please feel free to edit what we provide as it can still be improved.

Download Ten Commandments for Patient Centered Care

Rx: The Quiet Revolution

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
Modern version of Hippocratic Oath

PBS April 2, 2015

In this inspiring 90-minute documentary, filmmaker David Grubin takes his camera across America to focus on the challenges and triumphs in our country’s health care delivery system. The four segments that comprise Rx: The Quiet Revolution introduce us to a diverse group of doctors, nurses, and health care professionals who are transforming the way we receive our medical care: lowering costs by placing the patient at the center of their practice.

Rx: The Quiet Revolution shows us what’s happening from Maine to Mississippi, California to Alaska.  You will see physicians, nurses and other healthcare professionals placing the patient at the center of their practice — transforming the way medical care is delivered while lowering costs and improving outcomes.

Filmmaker David Grubin brings you these compelling stories: 

• In Maine, we meet Dr. David Loxterkamp, who practices family medicine with a team of doctors working to treat patients with chronic illnesses.

• In Mississippi, a state with more diabetes cases than any other, Grubin finds a rural health clinic fighting diabetes with the aid of an electronic communications device that provides greater access to medical care, helping patients take responsibility for managing this devastating chronic disease.

• In San Francisco, Grubin visits a health care facility for seniors called On Lok, dedicated to making it possible for frail, elderly Americans in need of nursing home care to live with dignity in their own homes.
  
  
• In Alaska, the documentary follows Native Alaskans who own and operate their own health system, caring for 65,000 people across 107,000 square miles. In spite of the number of patients and the vast distances between them, they are determined to foster an empathetic relationship between patients and their health care providers.

At 90 minutes, this may seem a daunting investment in time, but Rx: The Quiet Revolution will speak to you in powerful and compelling ways.

Parients as Partners

from Patients As Partners web site

Do you know what your patient is thinking?  BMJ 2015; 350

This is a new series in the British Medical Journal that puts the patients on the podium as teachers for physicians and other health care workers.

“Though patients and carers are becoming more involved in the ongoing education of healthcare staff, we rarely have the chance to set the agenda for what we would like you to learn. In our new patient led and patient authored series, What Your Patient is Thinking, we hope to redress this balance a little. The points made will range from practical hints and tips for meeting needs specific to certain conditions through to challenges to the medical status quo. What they will all do is offer practical things you can do differently tomorrow as a result of reading what we have to say.”

The first essay, Why there’s no point telling me to lose weight
BMJ 2015; 350, is powerful, hard-hitting and insightful.  It highlights how off-putting some medical visits can be for patients.  It is worth studying.

There is so much more to learn, and it appears that we have ignored a vital resource in our professional education: our patients and their families.  The BMJ is pointing us towards the obvious.  It is sad that so little ink has been spent on this area.

Other resources include:

Patient Voices Programme (U.K.) is partly an attempt to redress the balance of power between healthcare clinicians and managers and the people they serve, and partly an attempt to give decision-makers a different kind of opportunity to understand the needs of patients – other than the dry results of surveys and statistics.

Patients as Partners | Patient Voices Network (British Columbia):
As experts in our own lives, we can provide health system decision-makers with important information about how to best serve patients and involve us as partners in our own care. It is important for patients to participate in decision-making so that B.C.’s health care system reflects the needs and priorities of those it serves—the patients.

There are probably many more initiatives.

The Smart Patient

an eBook by Gina Kolata

Americans are inundated with medical information. It comes from every direction -- the media, the Internet, well-meaning friends and acquaintances, and an ever-proliferating collection of journals. In 'The Smart Patient -- Mistakes We Make About Our Health -- And How to Avoid Them,' Gina Kolata of The New York Times provides guidance in sorting through this welter, helping readers to make better decisions for themselves. Kolata, one of the country's most respected medical journalists, tells why anecdotal evidence should be viewed with skepticism, why large random studies are more trustworthy than observational ones, when a second opinion is a must, and what questions you should ask your doctor and -- equally important -- what ones you need to ask yourself.

I saw an ad for The Smart Patient in the NY Times and downloaded it to a Kindle.  It's also available for the Nook.  This is a short book, might take one to two hours to read and there is much for patients, their families and all care givers (including physicians) to ponder over.  It's well worth the $2.99 price.

Here's a short review: Download The Smart Patient

I welcome any thoughts you may have and I will add your comments to this post.

The Right Care Declaration

A Message from Vikas Saini and Shannon Brownlee of the Lown Institute:

The Declaration of Principles of the Right Care Alliance.

“The Right Care Alliance is a movement of clinicians, patient advocates, community leaders, and patients who see that overtesting, overdiagnosis, and overtreatment are endemic to modern health care – they are built into the culture of modern medicine. We see overuse as the flip side of the coin of undertreatment and lack of access, and a major cause of harm to patients."

They came to “understand the power and importance of coming together, to share our concern about practices that harm patients, and our belief in the moral necessity of working together to reduce overuse”

With colleagues, Vikas and Shannon created The Declaration of Principles of the Right Care Alliance.  Please read it and consider joining this Alliance by signing this declaration.  It will demonstrate your solidarity with the movement to assure all of us compassionate, safe and appropriate care.

 

Medicine Men by Elaine Zeichner

I have an otolaryngologist
Who treats my sinusitis.
An orthopedic surgeon who’s
In charge of my bursitis;
A gastroenterologist
Who probes and writes Rxs
Whenever my complaints are lodged
Around my solar pìexus.
A trusted ophthalmologist
who sees to how I'm seeing,
A psychiatric expert for
Emotional well being;
A noted rheumatologist
To manage my arthritis,
And yet another specialist
For warts and dermatitis;
A leading cardiologist
To regulate the heart of me,
A team of radiologists
Who've pictured every part of me.
And yet, with all their wherewithal,
They heal themselves, I’m told,
With aspirin, tea, and chicken soup
Whenever they catch cold.

Download Zeichner Poem

Author Bio:  Elaine Zeichner was born in New York City and is a graduate of Hunter College.  While at Hunter, she honed her creative talents writing lyrics for “Sing.”  She and her husband lived in Fresh Meadows, Queens, NY where they raised their two children.  After 25 years as a NYC schoolteacher, Elaine and her husband relocated to South Florida. She continues to enjoy dabbling in poetry and creative writing.

Photo is on Jainworld.com site.

Ms. Zeichner's poem reminded me of the parable of the blind men and the elephant.  Each of her specialists sees only a part of her.  Where is the generalist of old?

Silver Dragons by Phil Delrosario

Stanford undergraduate, Phil Delrosario, does an amazing job of getting into the mind of a four year-old at a doctor's office.

"Momma, why is she hurting me? Momma wouldn't say anything. She just held me there. The lady stabbed me again with another silver dragon. Stop I yelled out. I was still crying. Why are you hurting me I screamed. She said she needed to give me two more and then she'd be done. She came closer and closer. I kicked her in her face. That's what Aladdin would have done..."  Download Silver Dragons

 

Author Bio:  Phil Delrosario is a junior in Human Biology with a concentration in Psychological Development in Children and Adolescents at Stanford University in California.  He enjoys writing, making short films, and playing his violin/piano/ukulele. He can be reached at [email protected].

Pediatric practitioner Brian Maurer has this comment:  "This unfortunate scenario is repeated daily in pediatric primary care practice.  An interesting twist: told through the eyes of a 4-year-old as imagined by a pre-medical student. see Brian's full comment"  Download Maurer