Healthcare Consumerism

The topic of how to effectively communicate with your healthcare provider is just a minor part of a larger movement in healthcare called "Healthcare Consumerism". I would suggest you all go to this URL http://fardj.prblogs.org/2007/01/30/grand-rounds-319/ to read an interesting Grand Rounds on the topic.

I appreciated that they mentioned this blog - "Cancer treatment and Survivorship" - within Grand Rounds.

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Courage and Cancer Survivors

I have wanted to talk about courage for awhile, but not really knowing what to say. Because of my "English, journalism training" I find myelf going back to the definition of words.
Some of the ones I found today include:

• The state or quality of mind or spirit that enables one to face danger, fear, or vicissitudes with self-possession, confidence, and resolution; bravery.
• COURAGE implies firmness of mind and will in the face of danger or extreme difficulty COURAGE, METTLE, SPIRIT, RESOLUTION, TENACITY mean mental or moral strength to resist opposition, danger, or hardship.
• The quality of mind enabling one to face danger or hardship resolutely: braveness, bravery, courageousness, dauntlessness, doughtiness, fearlessness, fortitude, gallantry, gameness, heart, intrepidity, intrepidness, mettle, nerve, pluck, pluckiness, spirit, stoutheartedness, undauntedness, valiance, valiancy, valiantness, valor. Informal spunk, spunkiness. Slang gut (used in plural), gutsiness, moxie. See fear/courage.
  

There are so many things I like about these defintions that I think are true for every cancer patient/survivor I have known -

1)spirit

2)ability to face danger and fear with confidence

3) strength to deal with hardship

4) and my favorites "spunkiness", "gutsiness" and "moxie"

As I thought about courage and patients and families I came across this blog so I hope you will go click on the link and read about a man of courage.

http://www.thecancerblog.com/2007/01/29/cancer-hits-like-a-brick-wall-takes-life-of-courageous-man/

And as the picture shows: "Maybe courage does NOT always roar; Sometimes courage is the little voice at the end of the day; that says I will try again tomorrow." And maybe it is indeed the angel that watches over our loved ones with cancer and provides the courage needed.

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Survivors' Viewpoints on Communication Importance

As I mentioned in my posting on January 21, 2007 my father, a retired physician, and I are writing a book for all patients and family members on communicating with your health care provider (physician, nurse practitioner or physician assistant). We are blessed to have such a wonderful project to work on together and fantastic publisher (Jones and Bartlett Publishers).

We would be very interested in any information/comments any cancer survivors’ and/or family members would provide for us. We would appreciate your comments on:

1) problems you have had communicating with your health care provider, and
2) what examples do you have of effective communication with your health care providers, and/or
3) what would you like health care providers to do differently to communicate with you?

You are welcome to put this in the comment section of this post with your name or without your name. We would appreciate this information because we have been asking individuals around the country but have NOT specifically addressed cancer survivors. I think it would be helpful to see if the input provided by cancer survivors’ and their family and friends is similar or different than other individuals who do not or have not had cancer. If you do not feel comfortable making a comment on this blog you may send an email to: crking@maknaus.com. We may not be able to reply to each comment or message but I can assure you each one will be read carefully and evaluated as to whether it has been covered in the book or needs to be added

This book is designed specifically to help anyone needing healthcare to be able to advocate for his/herself or family and friends. This is a way of putting the focus of healthcare back where it belongs - "on the patient and family".

P.S. The image is of the 2nd edition of another book I published with Jones and Bartlett Publishers on Quality of Life.

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Successful Communication Skills for Cancer Patients

Just the diagnosis of CANCER is enough. Your brain wants to shut down at that time. The doctor has to be wrong about the diagnosis or have the wrong person. But as it does sink in and you begin on your cancer journey, there are a couple of tips I like to give any patient.

First, whenever you go to the clinic or hospital to see a new health care provider or get results of tests that may be positive or negative, try to bring a family member or friend. This person can serve as a second set of ears. They will hear things you will not remember. They also may think of questions to ask that you may not think of. Lastly, they can serve as an advocate for you. You might need someone to say "wait!!!" my friend needs all the options and a few days to think about it first. There are some rare cases where it is essential that treatment start immediately, but most treatments for cancer can be postponed a few days or weeks. You may even want a 2nd opinion. If you cannot take a friend or family member then take a tape recorder and ask the doctor to let you tape the conversation so you will remember all the important points. Then you can play back the audiotapes when you are at home.

The other tip I suggest to all patients (especially cancer patients and ones that have a chronic condition). Buy a notebook. Any size will do. Some like the small file card size to put in their pocket or purse. Others like a 3 ring binder.

Before you go to a doctor's visit or enter the hospital write down all the questions you have so you do NOT forget to ask them during the visit. Allow enough space to write the answers in or have your friend or loved one write down the answers. Write down any terminology you do not understand and have the health care providers explain it to you. Let the doctor draw things for you in the notebook so you understand. You can also keep track of any instructions while you are at the visit (like the names of new medications, when to take them, what side effects to watch for). You can also ask for a copy of laboratory tests and then when you get home you can scotch tape them inside the notebook. Some individuals also like to track how they are feeling every day in the same notebook.

These are just 2 of the top tips I recommend to all patients. I hope they will provide some hope and help in the future.

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Health Care Providers or Professionals

Before we delve too much into the problem of lack of effective communication skills of the health care provider (or professional) with the cancer patient and family member. It is helpful to be sure we are talking about the same terms.

Overall I like to use the term health care provider as someone (male or female) who is licensed to prescribe care for the patient. In general in the U. S this involves the following individuals:

• Physician (MD): a licensed medical practitioner, a person who practices medicine, a person licensed as a medical doctor by the jurisdiction in which he/she is resident to practice the healing arts
• Doctor of osteopathy (DO): Doctor's degree in Osteopathy which is a system of medicine based on the theory that disturbances in the musculoskeletal system affect other bodily parts, causing many disorders that can be corrected by various manipulative techniques in conjunction with conventional medical, surgical, pharmacological, and other therapeutic procedures.
• Nurse Practitioner (NP): a registered nurse (RN) who has completed additional courses and specialized training. Nurse practitioners can work with or without the supervision of a physician. They take on additional duties in diagnosis and treatment of patients, and in many states they may write prescriptions. Registered nurse with a master's or doctoral degree.
• Physician Assistant (PA): A trained, licensed individual who performs tasks that might otherwise be performed by physicians or under the direction of a supervising physician. A health care professional who is trained and licensed to practice medicine with a supervising physician.

These are key terms to remember especially when making appt. If you do not want to be seen by the PA or NP you should state this in the beginning. In some offices the MDs do all the procedures, injections and surgeries and the NPs and PAs can schedule longer time with the patient during a visit. These are the key providers who can provide prescriptions.

There are many other individuals who help run your physician's office. These can include:

Registered Nurse (RN): A nurse who has graduated from a formal program of nursing education (diploma school, associate degree or baccalaureate program) and is licensed by the appropriate state authority. An individual who holds a current license to practice within the scope of professional nursing in at least one jurisdiction of the United States.

Receptionist: A secretary whose main duty is to answer the telephone and receive visitors. The receptionist is an office/administrative support position. The work is usually performed in a waiting area such as a lobby or front office of an organization or business. The title "receptionist" is attributed to the person who is specifically employed by an organization to greet any visitors, patients, or clients.

Secretary: The secretary is an office/administrative support position. The title refers to a person who performs routine, administrative, or personal tasks for a superior. These office employees perform duties such as typing, computer processing, and scheduling for an executive. Secretaries are often hard-working, important members of a business who know its administrative workings better than anyone else. They usually work at desks in offices.

Billing Clerk: Medical Billing Clerks are responsible for compiling and maintaining records of charges for goods and services rendered at any health care facility. Once they calculate the total amount due from a patient, they must prepare invoices to be sent out and ensure prompt payment. Another major responsibility for a medical billing clerk is to contact insurance companies to determine what goods and services will be reimbursed and for how much. Most medical billing clerks use sophisticated computer programs that allow them to calculate charges and print bills in one step. These programs also serve as a safety net because the biller has to verify the information that is entered and correct any errors before the bill is printed and sent to the patient. Other responsibilities may include handling follow-up questions from patients, resolving discrepancies or errors, and ensuring that all billing and accounting records are kept in a safe place. Billing clerks may work part-time or full-time, as well as evenings and weekends depending on the type of employment. Individuals interested in medical billing must be highly organized, pay close attention to details, have good analytical skills, and be able to work well under pressure.

All of these individual's are human beings and are trying to make sure you are provided with the best treatment. We will discusss these individuals and how to improve communication over the next week.

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Communication between Health Care Providers and Cancer Patients

I recently received an email from "A grieving granddaughter in Mississippi" who was upset, disappointed and discouraged with the lack of effective communication between the health care providers and her family over her grandmother's diagnosis, treatment options and respect.

This is an essential topic to address currently whether dealing with cancer patients or individuals with other diseases. For many years physicians and other health care providers were given very little information on communicating successfully with patients and families or other health care providers. I was fortunate, I had a role model. My father, Dr. John King, is a retired physician. When I was growing up I would spend time with him at his office or the hospital and everyone used to tell me how wonderful he was with patients and families. Sadly, many others have not been as fortunate.

There is some good news though. Medical schools, nursing schools and other health care disciplines are beginning courses on communication. Some even videotape the students and critique them.

The other good news is that my father and I are writing a book that will be out soon that is designed for the patient and family and how you can improve communication with your healthcare provider (physician, nurse practitioner etc).

I am saddened that "A Grieving granddaughter in Mississippi" had such a horrible experience with the care of her dear grandmother. But there are things you can do to be an advocate for your loved one. I will discuss some of these in the next few posts., but remember you can always switch health care providers or get a second opinion. I hope at least for this granddaughter that her beloved grandmother (who has chosen no treatment) may pass without excessive pain and suffering.

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Optimism - Part VIII - How Your Emotional Computer Feeds Back

HOW YOUR EMOTIONAL COMPUTER FEEDS BACK

Your mind is like a computer. Everything you have experienced and known is recorded in your mind and is ready to play back and affect your reactions to people and situations. There are basically three emotional positions that will dictate how you react to your cancer and any situation. This is important because you can change this and it has been found that cancer patients who find new ways to cope emotionally or new strategies go on and use these in the rest of their life when they have to deal with stressful situations.

1. “I will act the way I feel!” (Emotional Position—EP—No. 1)

• This is what you tell yourself when your emotions are in control. You learned this reaction very early in life. It was the way you acted when you were a child.
• When you are acting the way you feel, it could be positive or negative. Your objective should be to strengthen the positive and reprogram the negative.

2. “You’re going to act the way I feel!” (Emotional Position—EP—No. 2)

• This is the second emotional position you might use to face situations. It is believed you acquired this programming from the authority influences in your life, particularly your parents. You learned that you must relate to the feelings of your parents. You were told to act a certain way, do things that you could not understand for no reason other than your parents “felt” you should behave that way. You asked, “Why?” sometimes and got the response, “Because I said so, that is why!”
• So now that you are grown up you can scold the dog, spank the children, criticize your marriage partner and throw your weight around, because none of these are doing what you “feel” they should do.

3. “I can not help the way I feel, but I can help the way I think and act.”
(Emotional Position—EP—No.3)

• This is the third position that you can use in reacting to situations facing you.
• This statement itself is used as an “affirmation” to reprogram your behavior.
• You are fully aware of the pitfalls or your early programming; you cannot help the way you feel. You realize there is nothing intelligent about emotions; anger, impatience, frustration, jealousy, anxiety and tensions.
  
• You can not help it that they appear from time to time. But you tell yourself that they will not control your thoughts and actions.This kind of discipline will eventually put you in complete control of your emotions and enable you to determine exactly the kind of person you want to be.

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Optimism Part VI- ACT

Despite the fact that some people say you cannot "learn" optimism or a more positive attitude, there is research to show that you can. This relatively easy way to improve your attitude may help during your cancer journey.

It is called:
How To Act Upon vs. Reacting To

Acting upon involves consciously choosing to do what will prompt a more positive response.

ACT to Limit the Harmful Effects of Others’ Negativity

A Affirm yourself. Halt negative self-talk

C Create measures to maintain your optimism.

T Take a “time out”. If necessary, find a reason to remove yourself from the negative interaction, even if only briefly for a “breather”.

One way to practice this is using the following exercise: Write one statement of negative self-talk you have expressed, then write a replacement statement of positive, affirming self-talk.

OR you might try writing down one thing you will do to develop and maintain a positive point of view.

Hopefully, some of these tips may help you increase or maintain your optismism.

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Optimism IV - Dealing with Fear Effectively

To eliminate fear and regain control, you must experience your fears and see how they limit you. Then you need to take steps to counteract those fears, control your anxiety, and move forward once again.

Positive thoughts are powerful.

• You can visualize your treament success.
• When you can imagine the way you really want your life to be, you vastly improve your chances of actually achieving your goal.
• Visualizing predicts success and motivates you to reach for the real thing.
• Visualizing trains you to think and act positively, to say “I can beat cancer!” and “I will get better!” instead of “I can’t” or “I’ll never.”
• Visualizing helps you push through fear so that you stop looking at the worst possibilities and focus instead on good things in your life - what life will be like when you recover.
  

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How to Think Optimistically - Part II

In our last article, we discussed how to interrupt negative trains of thought. Remaining optimistic while undergoing cancer treatment is paramount to a better recovery. Today, we will discuss two other states of mind that we need to be aware of and deal with effectively: 1) selecting the negative, and 2) generalizing.

Selecting The Negative:

Many people have an interesting internal screen that seems to keep out positives but lets in negatives. When someone compliments them, they discount the compliment as a courtesy and erase it from their memories quickly. But if we criticize them the memory of that hurt lingers. Some of us can replay the criticism in minds and can still recall it word for word years later.
This is due largely because of conditioning. Pessimism and hopelessness become almost a knee-jerk reaction. Our reactions become so instinctual that we do not realize how blinded we have become to the good around us. As we deal with cancer, we must remain positive. Having a positive attitude has been shown to be extremely helpful to cancer patients

Generalizing:

There is a logical fallacy that many of us experience frequently: from one incident we jump to all sorts of wild generalizations. On one hand, certain people, when they fail, refuse to see it as permanent ("My initial cancer treatment did not work, but I am hopeful that the next one will work"). These optimists do not assume that if they’re having trouble in one area, they’ll have the same difficulty in every area. They tend to question the circumstances. Also, optimists usually see the setback as due to circumstances that can be changed (that you can be healed of the cancer). If the initial treatment did not work, they continue seeking other treatments and then formulate a plan of action. It has been shown that individuals who tend to "problem solve or keep active actions of plans tend to do better when undergoing treatment for cancer.

Strive For Favorable Conclusions.

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Optimism - Part III

In dealing with cancer, we must be careful of not falling into what is called the "victim role"
Some of our thoughts in the victim role may be: "It will never get better. Things will never change. My cancer illness will get worse. A disaster is going to occur. I’m unlucky."
Along with these thoughts are some possible related beliefs.

Possible related beliefs

"The best part of my life is over. I’m unhappy. I can’t help it. Life is hard."

Life choices

There are some life choices that we make as a result of these beliefs. We may stay with the status quo. We may make small changes or take small risks.

Ego advantage

Some thoughts about life as a victim may include: "I know about life. I'm realistic. I have a special tragic role. I'm different. Poor me."

Judgment of others

In our relationship with others, as a victim, we may think: "They are unrealistic (my family regarding the cancer treatment). They are living an illusion. They'll soon find out." In the victim role, we may also "select evidence from the present."

Selective evidence from the present

We may see all the aspects of life that are unchanged. We may ignore everything that has changed for the better. We may focus on one small aspect of a change that does not go so well.

Beware of the victim role. Battle against these negative thoughts. It is crucial to do so.

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