Entries by My Health E

Improving Patient Outcomes Through Education

The future of healthcare is looking brighter thanks to technological advancements. And yet, so many advances fall silent, and patients do not reap the benefits. Advances in healthcare should be a human experience. However, if advances are not made known by the community, how can they be utilized?

Opioid Beneficiary Fact Sheet

Prescription opioid pain medications—like oxycodone (OxyContin®), hydrocodone (Vicodin®), morphine, and codeine—can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose, and death.

Age Friendly Louisville — March 5, 2019 Meeting

On average, one primary care physician in Jefferson County serves 1,059 individuals, one dentist serves 1,021 individuals, and one mental health provider serves 375 individuals. There are 54 preventable hospital events per 1,000 Medicare enrollees. One in ten people are uninsured, and two in ten adults do not have a regular doctor. There are per 100,000
Jefferson County residents, 18 liquor stores, 12 recreational and fitness facilities, and 21 grocery stores. Two in ten residents live in a food desert and two in ten are food insecure. Two in ten residents are smokers, two in ten are excessive drinkers, three in ten are obese, eight in ten consume inadequate amounts of fruit and vegetables and three in ten do not participate in physical activity. Overall Jefferson County ranks 28th in terms of health outcomes and 57th in terms of health factors in the state of Kentucky.

Survey respondents indicate that most have health insurance through Medicare. Five in ten indicated a disability, either a personal one or a partner with a disability or both. Five in ten rated their health as excellent or very good. Six in ten engage in physically activity, and nine in ten feel it is important to remain physical active as long as possible. Fifteen percent of
survey respondents use prescribed opioid medications, with 50% of those using it for more than five years. Five in ten of these residents are interested in participating in alternative pain management strategies. Respondents to the survey indicated a 36% average gap between needing community support and health services resources and what is available in
the county. According to the Age Friendly Index, Jefferson County scored 48% in this domain, not meeting the 50% threshold for age friendliness.

Hospitals are Scary for Patients

My brother Iain had Duchenne muscular dystrophy. In the genetic lottery, it’s a pretty ghastly set of cards to draw. From a normal start in childhood, most affected boys never get beyond a limited ability to walk, followed by slow wasting over several years until they cannot manage even the simplest of daily tasks.

Around the time in question, when he was in his mid teens and I was a medical student, Iain ended up in hospital. I don’t recall how long he was there, though it seemed like several days. What I do remember is that there could not have been a more unsuitable environment for a disabled teenage boy. 

When you are living with a disability, one of the coping strategies is to develop your own routine. The problem with hospitals is that they too work to a routine. And it’s unlikely that the pattern of yours and theirs is going to match. I remember clearly that Iain needed help to be turned approximately every hour overnight. At home he would call out, one or other of my parents would shuffle through, adjust his position, and then return to bed before being called again around an hour later.

In hospital, however, patients were turned according to when the charts said they should be. We were distressed to think of Iain being turned according to a timetable rather than “as required.” Each time he dropped off to sleep he was woken for a routine “turn,” then lay awake at other times begging for a shift in position only to be told it wasn’t the time yet. He hated every minute of it.

The power imbalance between patients, their families, and the staff in hospitals can be very scary. It can be hard to question what is happening, or to ask for more information. As a family, we were concerned to find the ward house officer returning repeatedly for more blood samples, without any explanation. This was a traumatic experience, with all four of Iain’s limbs being contracted and misshapen. Venepuncture was challenging for both doctor and patient, and on the last occasion was undertaken by the appropriately named “femoral stab.”

Finally, my mother plucked up the courage to ask what was so wrong that he needed so many samples. It was hard to know how to react when we were informed that the problem in fact lay with a faulty laboratory analyser.

We knew he wasn’t thriving in hospital and within a short time my parents made the decision to request that he be discharged home. They were terrified that this would tarnish my future prospects as a medical student, but felt they had to act.

The story has a happy ending, in the sense that Iain did get home.  My parents simply scooped him up into his wheelchair and brought him back to the house. It took him a while to recover but he did over time.

Iain later died in his sleep at the age of 21, part way through an Open University science degree. He had several more fulfilling years and he certainly got something out of seeing me through to qualification as a doctor. He had a clear view that he would never be admitted to hospital again.

I sometimes wonder whether the story would play out the same way today—there is much talk of being “patient centred” and holistic, so perhaps the difficulties we experienced back in the 1980s would not be a problem now. Although when I’ve spoken with friends who are disabled, it seems that the mismatch between patients’ and healthcare professionals’ routines in hospital can still be a problem, even in 2018.

Perhaps bizarrely, my experience as Iain’s sister made me more determined than ever to work as a hospital doctor. With the optimism of youth, I had a sense that I could change the world. I couldn’t help feeling that there had to be a better way to do this—that we might work in partnership with patients and their relatives. Over 30 years on, I think we still have work to do.

Since the outset of my medical career, I have seen myself as a translator. Whether it’s for patients or their families, I have tried to interpret for them the mysteries of their illnesses and the treatments we offer. I feel passionately that we need to provide written information for people—it’s hard to take in new information when you are scared and vulnerable. So ever since I was a house officer, I’ve been scribbling notes for people and drawing them pictures.

We need to do everything we can to redress the imbalance, not only in power and knowledge, but also in our respective states of mind. Many of our patients may be feeling scared or even frightened witless when, for us, it’s just another day at work.

And, remembering those multiple blood samples, I’ve never forgotten the importance of a good apology. Even if it isn’t your fault, saying sorry is important to break down the barriers of lost faith in the system. We all want a good outcome.

I’ve always disliked the phrase “discharged against medical advice.” If someone wants to leave the hospital, they will have their reasons for doing so. And rather than judging people, I believe we should support them.  

My Mum is less wary of doctors than she used to be. But I carry her words with me to this day.

Reports of the Surgeon General, U.S. Public Health Service

The Surgeon General of the Public Health Service has focused the Nation’s attention on important public health issues. Reports of the Surgeon General on the adverse health consequences of smoking triggered nationwide efforts to prevent tobacco use. Reports on nutrition, violence, and HIV/AIDS—to name but a few—have heightened America’s awareness of important public health issues […]