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medical harm

Experts at Johns Hopkins state that medical errors may be the third leading cause of death.

The news stories that make me squirm the most are the ones showing the failures in health care. As a nurse, I took great care to not harm anyone, and hopefully to help everyone under my watch. I made a few mistakes, but nothing serious. I was honest about my errors, and always told my patients about my mistakes, and the measures I took to correct them. Thank goodness, no one was harmed.

The other thing I did was to use my mistakes to educate patients. I instructed them and their families on how they could participate in their health care. Although the mistakes I made were relatively harmless, I knew that more serious medical errors happened. Perhaps I could show patients and families how to advocate for themselves, and reduce their chances of experiencing a medical mishap.

I’ll spare you the statistics, other than this one: Experts at Johns Hopkins state that medical errors may be the third leading cause of death. Let this sink in for a moment. Many of us are going to great lengths to stay healthy, trying to minimize our risk of heart disease and cancer. But how do you reduce your risk of getting hurt by the people you trust?  It turns out, there are precautions you can take to reduce your chances of being harmed by medical errors.

Ways to Protect Yourself

  1. Take good care of your health. If you aren’t sick, you won’t need medical intervention. But if you do need medical help, seek it early before your problem gets big and complicated.
  2. Choose your health care team carefully. Get recommendations from others. Check your doctors’ credentials. Look at online ratings.
  3. Trust your instincts. If you don’t feel comfortable with your doctor, look for a new one. Your doctor should answer your questions and come across with a reasonable amount of confidence in his or her ability to care for you. Too much self-confidence, such as arrogance or condescension is not a quality that I like. However, I was okay with a bit of egotism coming from my husband’s neurosurgeon. Since God wasn’t going to be doing the surgery on my husband’s brain, it seemed fitting that someone who thought he was God would be doing the job.
  4. Bring someone with you to your appointments. A good advocate can hear things we don’t hear, and say things that we might not think to say.
  5. Read everything you can on how to stay safe. Here are some great resources:

If you want more information about the hazards of health care, I highly recommend reading ProPublica’s in depth reporting on patient safety. ProPublica provides top-notch journalism beyond the usual short bytes found on today’s web-based news sites. ProPublica’s reporting can be frightening, but it is information that we need to know.

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Can Loneliness Kill You?

Alan

Hanging out with my buddy Alan Franciscus

This year, Britain’s Prime Minister Theresa May appointed a minister of loneliness. This may sound right out of Monty Python, but I assure you this is real. Loneliness is associated with an increased risk of multiple medical problems, including heart disease, stroke, and premature death.

There is a substantial amount of evidence showing the potential deleterious effects of social isolation on our health. The largest body of evidence comes from Julianne Holt-Lundstad and colleagues. (http://julianneholtlunstad.byu.edu) Holt-Lundstad and others reviewed tons of studies and found that social isolation, loneliness, and living alone are associated with risk of early death. In fact, this association is even stronger than obesity when predicating risk of premature death.

Rather than discuss all the evidence, I’ll point you to a couple of good videos to view. Learn about the seriousness of social isolation here:

What You Can Do to Combat Loneliness

Obviously, the cure for social isolation is to take steps to lessen the isolation. But telling someone that they need more friends is like hearing my mother tell me I need a hobby. If making friends was easy, surely we would.

In a recent Scientific American (January 2018), Francine Russo explored social isolation in her article, “The Toxic Well of Loneliness.” The solutions seemed a bit “off” to me. Cognitive-behavioral therapy (CBT) is useful; so is meditation. Medication, Skype, and robotic pets were also mentioned. Personally, I hope England’s Minister of Loneliness comes up with better options.

Perhaps the solution is best found by connecting people such as myself who are not socially isolated with those who are. I am not suggesting knocking on the doors of strangers and inviting them over for a cup of tea. I can however, identify people I know and invite them over for a visit or call them regularly. Surely the world would be a better place if we watched out for each other a little more.

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opioids

Still flashing my own teeth

When I was a kid, all my grandparents had dentures. Eventually my mother would need them too. However, my great-grandmother managed to keep her teeth. When she died, people remarked that she had all of her teeth, said with the same awe-filled tone that one might remark that she had climbed Mount Everest.

My mother stressed the importance of  good dental hygiene. Her goals for me were simple. She wanted me to attend college and have my own teeth. So far I’ve done both.

When I go to my dental appointments, the dentist asks about my medications. Honestly, I have always treated this part casually. It was not until a recent appointment that I learned how important a full health history is for the well-being of my teeth.

She asked me if there were any changes in my medications. I tossed out that I’ve been taking Norco for a herniated disc in my neck. I probably wouldn’t have mentioned it except for the fact that I was about to submit my neck to an hour in a dental chair.

She asked me how much I was taking, how often, and if my mouth was dry. I said I was only taking the medication sporadically, and hadn’t noticed any drying effects. To which she said, “If you need to increase your use of Norco and notice your mouth getting dry, let me know.”

Now I was curious, especially since I know quite a few people who use opioids on a regular basis. My dentist proceeded to enlighten me. I’ll share what I learned at the end of this blog, but first a paragraph of basic information.

Hundreds of drugs will cause dry mouth. These include pain meds, antihistamines, decongestants, antidepressants, high blood pressure meds, and so on. In the old days of using interferon to treat hepatitis C, dry mouth was a nearly universal side effect. To help, we’d suggest drinking lots of water, sucking on lozenges, chewing gum and using dental products formulated for dry mouth. These all helped, but may not have gone far enough.

My dentist told me that when the mouth is consistently dry, the body tries to compensate by changing its pH level. This response actually causes risk of tooth loss. Adding moisture doesn’t correct the problem; it only makes it feel better. To prevent tooth loss, people with dry mouth need to use a fluoride rinse. She suggested starting with an over-the-counter rinse, but if I were to be on a steady dose of opioids, I needed a prescription fluoride rinse.

Who knew? Well, now we do.

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I am not feeling like a geezer here…

This week I realized that I look the age that my driver’s license says I am. I gave an acquaintance a ride, a man in his thirties. He told me that I look like his aunt. When I stopped at the gas station, he leaped out to fill the tank. When we stopped at the post office, he grabbed my mail and took it inside. It was like being helped across the street by a boy scout.

The odd thing about aging is that I don’t feel as old as I am. I feel like life is looming large all around, although arithmetic tells me otherwise. (If you are wondering how old I am, I can tell you that my mailbox is filled with offers relating to Medicare insurance.)

Remember when we were kids and people would ask us, “What do you want to be when you grow up?” No one has asked me that for a very long time. However, I still have dreams, plans and goals. I am moving forward.

That said, the truth is that age is advancing on me. I can’t ignore this fact, or the greater truth, which is, that I will die eventually. So the question is, “What do I want to be when I grow old?”

I want to be alive, completely alive. I want to sway in the breeze of life, rather than push against it. I want to love fully, act heartily, and accept graciously.

Staying healthy helps. I work hard at staying healthy. It means sleeping 8 hours regularly, being physically active, eating well (and not too much), and balancing work and play.

Aging gracefully means accepting help. I am perfectly capable of pumping my own gas and carrying my mail into the post office. But sometimes we also have to give the gift of letting others be helpful. My helpful boy scout friend probably felt like he was doing a good deed. If I made him happy, that’s a good thing. One day I may need his help. This was good practice.

What do you want to be when you grow old?

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When Transplant Recipients Become Olympians

What do you need to do to be a winner?

Commercials for the 2018 Winter Olympics are popping up. This year it is especially interesting because North and South Korea will march together under one flag. They agreed to march under a “unified Korea” flag depicting an undivided Korean Peninsula.

I don’t watch the Olympics for the sports; for me it is about the human spirit. Many of the participants have overcome serious obstacles. In recent news, we heard about the horror that Simone Biles and other gymnasts endured when the team doctor repeatedly molested them. They aren’t the first, nor will be the last. Rape, molest and other acts’ of sexual misconduct aren’t just limited to females. It happens to males as well. And although the perpetrators are often men, women are capable of heinous acts too. Regardless, we need to speak up and take action to stop this.

Back to the Olympics. These games show the power of determination, dreaming, training, and support. The same elements that propel an athlete to compete in the world arena, are the same elements that all of us need to survive and thrive during illness. It’s not enough for me to rise above my medical conditions; I want to be healthy.

The trick about being healthy is that often you have to stretch yourself when you don’t feel like it. It may begin with getting out of bed when your body just wants to be horizontal. It can start with drinking a full glass of water when you’d rather have a soda. It may mean fighting the urge to watch an extra hour of your favorite show, and instead going to bed and treating your body to sufficient sleep.

When I need a boost, I think about athletes who participate in the World Transplant Games, Paralympics, and Special Olympics. They all started with disadvantages. My disadvantages are really minor compelled to losing a leg or nearly dying from organ failure. Each athlete started from ground zero.

If you are at ground zero, what first step will you take to begin your journey towards health? What do you need to do to be a winner?

Click here to see the results of the recent World Transplant Winter Games held in Switzerland.

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Maximizing Your Medical Appointment

Take notes either on paper or via your phone.

Last week, I discussed the issue of building trust with our medical providers. We take a huge gamble when we place our lives in the hands of physicians and other health care professionals.  In my last blog, I talked about how to find a doctor and make an appointment. This week I offer tips on how to best use your time together.

When you meet the doctor, there are ways to maximize your brief time together. Here are a few suggestions:

  • Make eye contact before speaking to the physician. Once you begin talking, your doctor may take notes. This does not mean s/he is not listening.
  • When describing your symptoms, begin with the general picture and end with the specifics. Example: My stomach hurts. I feel nauseous in the morning.
  • Discuss subjective information first and then move to the objective and/or quantifiable.  Example: I feel tired. I have slept 15 hours nearly every night for the past 3 weeks.
  • Describe the impact the problem has on your life. Example: I am so tired I am unable to exercise.
  • Be brief and prioritize.  Start with the most important details and if there is time, you can add the less important information in at the end.
  • Ask for clarification. If your doctor uses words or explanations you do not understand, ask her to clarify or simplify her words.
  • Take notes. If the doctor makes suggestions, write them down either on paper or via your phone. Ask him to spell any words you might want to refer to later, such as a diagnosis, medication or procedure.
  • Take a friend. This is especially important for appointments that may be long, complicated, or not routine. Ask your companion to take notes for you.
  • Express any reservations. If your doctor suggests a treatment plan that you have some concerns about, say so. Sometimes these concerns can be easily addressed.
  • Ask if there are any alternatives. If your doctor makes a treatment suggestion and it is not one that you are prepared to follow, ask about the alternatives.
  • Keep an open mind. This can be your strongest ally. It is amazing how many people will not try a medication because of their fear of side effects, only to find out later that the reality was not anywhere near their imagination.
  • Maintain your own health records. It can really help expedite matters if you bring copies of your most recent pertinent laboratory and biopsy results.
  • Discuss the follow-up plan. If you are scheduled to have diagnostic tests, ask the doctor when you can expect the results and how these results are conveyed to you. If the results are going to be disclosed at your next appointment and if there is going to be a long interval between appointments, ask how you can obtain earlier results.

It usually takes more than one appointment to establish trust. First impressions are not always right. Even the most personable and capable physicians have bad days. Patients do not always make great first impressions either. We are often scared and hide our fear with defensiveness or other mechanisms that inhibit a good relationship. If you do the groundwork, in time the relationship will strengthen. If it does not, look for another doctor. It is your right. Remember that you are the leader in your health care team. You are managing your care; not your physician and not your insurance company.

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