“Mission creep doesn’t benefit patients at the end of life” (Washington Post)

This compelling story in today’s Washington Post (washingtonpost.com) is about a physician having a conversation with his physician father, age 88. Here’s an excerpt:

“We were discussing treatment options promoted by his primary-care physician and other doctors for an aortic aneurysm… He turned to me and asked, ‘Why would I want to fix something that is going to carry me away the way I want to go?’ … With his unexpected question, he directly challenged the assumption that a doctor’s advice is always in a patient’s best interest, particularly regarding a medical problem late in life. … Furthermore, Dad was making an important distinction, between care at the end of life (in this case, palliative care for pain) and treatment (aneurysm repair). He was also suggesting a natural exit strategy.”

Here’s a link to the full article:

https://www.washingtonpost.com/national/health-science/mission-creep-doesnt-benefit-patients-at-the-end-of-life/2016/08/22/3664630c-032e-11e6-9203-7b8670959b88_story.html

Health & Science
Mission creep doesn’t benefit patients at the end of life
By Samuel Harrington
The Washington Post
August 22, 2016

Robin

 

“Tips for talking with your doctor”

The National Institute on Aging has put together a set of tips for talking with your doctor.

The NIA points out that:

“You only have 18 seconds — that’s the average time a doctor waits before interrupting a patient.  Be prepared for your visit:
1) Make a list of concerns in order of their importance to you.
2) Write down all your medications, vitamins, and supplements.
3) Note all health and life changes since your last visit.”

The NIA has a “Guide for Older People: Talking with Your Doctor,” available here:

www.nia.nih.gov/health/publication/talking-your-doctor/opening-thoughts-why-does-it-matter

Of that publication, I thought the webpage on “Getting Ready for Your Appointment” was the most helpful.  I’ve copied it below.  (This publication is available in Spanish.)  It includes a list of tips on getting started with a new doctor.

And there are some useful worksheets at the end of the publication worth printing out and using.  The worksheets list concerns, diet changes, medication changes, lifestyle changes, thoughts/feelings, other changes, and medications (name of drugs, what it’s for, date started, doctor, color/shape, dose and instructions).  See:

www.nia.nih.gov/health/publication/talking-your-doctor/your-convenience-worksheets

You could download the PDF and print the worksheets out from there. It might be useful to print out the worksheets and place them on your refrigerator door.  Whenever something comes up that you think you’d like to tell your doctor about, you can add it to the worksheet.

Robin


www.nia.nih.gov/health/publication/talking-your-doctor/how-should-i-prepare-getting-ready-appointment

Excerpt from:
Talking With Your Doctor: A Guide for Older People
National Institute on Aging
Publication Date: April 2010

How Should I Prepare? Getting Ready for an Appointment
Last Updated: July 29, 2016

Overview
– Be prepared: make a list of concerns.
– Take information with you.
– Consider bringing a family member or friend.
– Make sure you can see and hear as well as possible.
– Plan to update the doctor on what has happened since your last visit.

A basic plan can help you make the most of your appointment whether you are starting with a new doctor or continuing with the doctor you’ve seen for years. The following tips will make it easier for you and your doctor to cover everything you need to talk about.

List and Prioritize Your Concerns
Make a list of what you want to discuss. For example, do you have a new symptom you want to ask the doctor about? Do you want to get a flu shot? Are you concerned about how a treatment is affecting your daily life? If you have more than a few items to discuss, put them in order and ask about the most important ones first. Don’t put off the things that are really on your mind until the end of your appointment—bring them up right away! Worksheet 1 at the end of this booklet can help.

Take Information With You
Some doctors suggest you put all your prescription drugs, over-the-counter medicines, vitamins, and herbal remedies or supplements in a bag and bring them with you. Others recommend you bring a list of everything you take and the dose. You should also take your insurance cards, names and phone numbers of other doctors you see, and your medical records if the doctor doesn’t already have them.

Consider Bringing a Family Member or Friend
Sometimes it is helpful to bring a family member or close friend with you. Let your family member or friend know in advance what you want from your visit. Your companion can remind you what you planned to discuss with the doctor if you forget. She or he can take notes for you and can help you remember what the doctor said.

Be Sure You Can See and Hear as Well as Possible
Many older people use glasses or need aids for hearing. Remember to take your eyeglasses to the doctor’s visit. If you have a hearing aid, make sure that it is working well and wear it. Let the doctor and staff know if you have a hard time seeing or hearing. For example, you may want to say: “My hearing makes it hard to understand everything you’re saying. It helps a lot when you speak slowly.”

Plan to Update the Doctor
Let your doctor know what has happened in your life since your last visit. If you have been treated in the emergency room or by a specialist, tell the doctor right away. Mention any changes you have noticed in your appetite, weight, sleep, or energy level. Also tell the doctor about any recent changes in any medications you take or the effects they have had on you. Worksheet 2 at the end of this booklet can help.

Request an Interpreter If You Know You’ll Need One
If the doctor you selected or were referred to doesn’t speak your language, ask your doctor’s office to provide an interpreter. Even though some English-speaking doctors know basic medical terms in Spanish or other languages, you may feel more comfortable speaking in your own language, especially when it comes to sensitive subjects, such as sexuality or depression. Call the doctor’s office ahead of time as they may need to plan for an interpreter to be available.

Always let the doctor, your interpreter, or the staff know if you do not understand your diagnosis or the instructions the doctor gives you. Don’t let language barriers stop you from asking questions or voicing your concerns.

 

Tips: Getting Started With a New Doctor

Your first meeting is a good time to talk with the doctor and the office staff about some communication basics.

First name or last name—When you see the doctor and office staff, introduce yourself and let them know by what name you like to be called. For example: “Hello, my name is Mrs. Jones,” or “Good morning, my name is Bob Smith. Please call me Bob.”

Ask how the office runs—Learn what days are busiest and what times are best to call. Ask what to do if there is an emergency, or if you need a doctor when the office is closed.

Share your medical history—Tell the doctor about your illnesses, operations, medical conditions, and other doctors you see. You may want to ask the doctor to send you a copy of the medical history form before your visit so you can fill it out at home where you have the time and information you need to complete it. If you have problems understanding how to fill out any of the forms, ask for help. Some community organizations provide this kind of help.

Share former doctors’ names—Give the new doctor all of your former doctors’ names and addresses, especially if they are in a different city. This is to help your new doctor get copies of your medical records. Your doctor will ask you to sign a medical release form giving him or her permission to request your records.

Work-arounds at home for safety, ease-of-use, etc. (NY Times, 8-15-16)

Here are the useful work-arounds (“hacks,” adaptive equipment, or environmental adaptation) I picked up from an article in this Monday’s New York Times and associated reader comments:

* “[Attaching] small tactile bumps to the ‘Answer’ button and the ‘2’ and ‘8’ keys on her phone, making it easier for [someone with vision problems] to respond to and make calls.”

* “Sugru, a moldable putty that turns into rubber, can be used to round out sharp corners on furniture in order to prevent injuries.”

* One of the commenters suggested checking out this webpage on the Sugru website; it’s a how-to guide for using Sugru for “assistive technology”:

sugru.com/guides?utf8=%E2%9C%93&context=Assistive%20technology

* “Rubber bands can be affixed to cups to make them easier to grip.”

* “A clothespin can be clipped to the rim of a cup with a drinking straw taped to it to hold the straw in place.”

* “[Hanging] an old stocking in a shower with a bar of soap tucked into the foot. As the soap gradually shrinks, it remains inside the stocking instead of a becoming a slipping hazard on the floor. The slightly abrasive nylon stocking material has the added benefit of exfoliating the skin.”  (One of the commenters asked:  “Who still has stockings?”)

* Another commenter suggested a “small mesh laundry bag (for lingerie) from the dollar store works well too, and usually has a drawstring.”

* One of the commenters suggested keeping shelf liner around your house, in your purse, and in your travel bag.  It’s handy for opening things and for keeping things from sliding.

Here’s a link to the full article, if you’d like to read more:

well.blogs.nytimes.com/2016/08/15/hacks-can-ease-the-trials-of-aging/?_r=0

Aging
Hacks Can Ease the Trials of Aging
New York Times
By Marie Tae McDermott
August 15, 2016 6:00 am

Robin

 

Keeping & Organizing Medical Information (tips for caregivers)

I stumbled across series of three posts by a geriatrician, Dr. Leslie Kernisan, from the summer of 2013.  The three posts in the series are:

1- Journal/notebook for notes and symptoms

drkernisan.net/tools-for-caregivers-how-journals-can-help/

2- Portable and up-to-date medication list

drkernisan.net/tools-for-caregivers-the-portable-up-to-date-medication-list/

3- Organizer to keep copies of medical results and medical records, and Personal/family task organizer.

betterhealthwhileaging.net/tools-for-caregivers-keeping-organizing-medical-information/

In the third post of the series, the author discusses:

* Why caregivers should keep copies of medical results and key health information
* The most useful types of medical info to keep copies of
* How caregivers can maintain a personal health record for an older adult

The final section on maintaining a personal health record was the most valuable.  Here’s the author’s “main recommendations regarding keeping and organizing medical information”:

“I do always recommend that patients and caregivers maintain some kind of personal health record (PHR), in which they at a minimum keep copies of test results.  It is perfectly ok to just maintain a folder or binder with this information on paper. However, keeping digital copies of the information provides a good backup. If you find an online PHR that makes it easy to enter information, this is a good option too.  If as a caregiver, you ever need to take an older person to see a doctor on short notice, having test results and an up-to-date medication list will go a long way towards ensuring that doctors can provide the right medical care.”

As far as an digital record is concerned, the author seems to have a preference for Microsoft HealthVault, healthvault.com.

And a reader commented with a good suggestion about the binder:  “Tape a large ‘IF FOUND, PLEASE CONTACT…’ note on the inside of the binder in case it gets lost.”

Robin

Risks of polypharmacy during and after a hospital stay (Washington Post, 8-15-16)

This Washington Post article is about the risks of polypharmacy — taking multiple medications — among the elderly, especially during and after a hospital stay.  The two angles of this particular article are that lots of medication is administered at the hospital that may not be needed, and patients bring home medication from the hospital (“souvenirs”) that may not need to be continued.

Some key excerpts from the article in today’s paper:

* “Older adults account for about 35 percent of all hospital stays but more than half of the visits that are marred by drug-related complications, according to a 2014 action plan by the Department of Health and Human Services. Such complications add about three days to the average stay, the agency said.”

* “Even if a drug doesn’t cause an adverse reaction, that doesn’t mean the patient needs it. A study of Veterans Affairs hospitals showed that 44 percent of frail elderly patients were given at least one unnecessary drug at discharge.”

* “Some drugs prescribed in the hospital are intended to treat the acute illnesses for which the patients were admitted; others are to prevent problems such as nausea and blood clots. Still others are meant to control side effects of the original medications.”

* “A 2013 study found that nearly a fifth of patients discharged from the hospital had prescription-related medical complications during their first 45 days at home. About 35 percent of those complications were preventable, and 5 percent were life-threatening.”

* A geriatric pharmacist working at a UCLA hospital “tries to answer several questions to determine what’s best for a patient. Is the drug needed? Is the dose right? Is it going to cause a problem?”

* “One of [the pharmacist’s] go-to references is known as the Beers list, a compilation of medications that are potentially harmful for older patients. The list, named for the doctor who created it and produced by the American Geriatrics Society, includes dozens of medications, including some antidepressants and antipsychotics.

Link to the Beers list

Access is free but you do have to register for online access.

Here’s a link to the Washington Post article:

https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html

Health & Science
‘America’s other drug problem’: Giving the elderly too many prescriptions
Washington Post
By Anna Gorman
August 15, 2016 at 3:51 PM

Robin