Contributor: Diana Dilger – Senior Health Writer, Emmi Solutions

Diana Dilger

Diana Dilger

Dr. Craig Bowron recently wrote an insightful article in the Washington Post about why people are unable to sidestep aggressive treatment with their elderly loved ones, mostly focusing on the feelings of guilt most of us have around not doing “enough.” Having done extensive research on end-of-life care, including a ride-along with a hospice agency social worker, I couldn’t agree with him more. Most people don’t want to let their loved ones – and, if they’re being honest, themselves – down. Somehow putting their sick loved ones through aggressive treatment that’s hard on the body (and hard on the caregivers, both emotionally and logistically) feels more active and more loving than letting the loved one lay at home without professional medical attention.

But do they really have to die at a hospital? With hospice, people can die in a comfortable, familiar place, not shoved full of tubes, or poisonous or harsh medicines. There are medical professionals to attend to the discomfort of dying and help caregivers with logistical decisions. And I know at this point, many people know about hospice and its benefits. I’m not preaching any ground-breaking news here.

What may be less discussed is the fact that most Americans want to die at home (Time/CNN poll, 2000). And I know what we say in a poll or what we think about strangers dying or death as an abstract concept, or even sometimes our own deaths can be an entirely different ball game from when we’re faced with the death of someone we love. Suddenly the feelings of guilt, of responsibility, of wanting medicine to “step up” and somehow stop death or prolong life take over.

But as Dr. Bowron points out, medicine can only do so much. And just because a treatment could prolong someone’s life, does that make it worth it? At some point we have to ask ourselves, to what end? What will this procedure accomplish? Is this worth the suffering or discomfort it may cause? Continue Reading »

Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions I was a two-sport athlete—soccer and Shotokan karate—for the vast majority of my life, culminating in my early twenties. I played competitive soccer through high school and college and eventually co-captained the Amherst Women’s Soccer team. Concurrently, I traveled all over the country and the world to compete in karate, and was a national team member starting at the ripe age of 13. In 2009, at 21 years old, I co-captained the USA National Karate Team at the WKC World Karate Championships. At the end of Worlds, I stepped off the podium the Middleweight World Champion and promptly retired from competitive martial arts. A season later, my soccer career was over, as well.

Why? Largely because I had pushed aside a variety of nagging aches and pains for years, and convinced myself that this wasn’t the time to deal with them—that they’d go away on their own or I could just handle the pain and tough it out. The consequence?At 21, instead of minor setbacks, those aches and pains had become serious injuries.

It’s with that history that I read and appreciated Jeff Haden’s recent article describing his pursuit of ever greater cycling challenges, and the insight he gained from a truly near-death health scare. The lessons he described resonated with those I also learned the hard way. And the relevance of those lessons doesn’t apply only to those injuries accumulated through years of athletics; they apply to all varieties of healthcare. Despite having both an academic healthcare background and personal history highlighting the importance of preventive and non-acute care, I still find myself dragging my feet on making those appointments. And for that, sadly, I’m in good company.

Putting aside for a moment questions of access to and affordability of such screenings, procedures and doctor’s appointments, there is quite a bit of evidence—anecdotal and quantitative—that suggests people just don’t seek out non-acute care with the frequency they should. Why is that? The answers are complicated and multifaceted, ranging from the macro-economic to the psychological. There is, however, at least one major factor on which the literature—as well as Jeff and I, as evidenced by our athletic escapades—agree: Denial.

Traditionally, the tendency toward denial and delay of seeking healthcare has—not surprisingly—been more strongly associated with men, but recent research has complicated this widely held belief. Women, it seems, are also prone to delaying care, albeit with different rationale. Gender aside, the result of denial and the delay of seeking care is significant: decreased survival rates in cancer, stroke and heart disease, among other diagnoses. Early detection proves powerful, but is only possible if people participate in those kinds of care aimed at catching early stage pathologies.

Continue Reading »

Contributor: Hailey Merk – Client Services Intern, Emmi Solutions

I hear my name called by what appears to be a nurse at my last routine doctor’s appointment. She records my height, weight and blood pressure but, to my surprise, doesn’t leave to call in the physician after she’s finished. She explains that she is also a primary care provider and will be assisting me with my healthcare needs. I am surprised, but the entire visit goes smoothly and I leave a happily satisfied patient.

You may have experienced a similar doctor’s appointment since the implementation of the Affordable Care Act because physician assistants and nurse practitioners have been freshly integrated into the healthcare system as primary care providers. The ACA defines a primary care provider as “a clinician who provides integrated, accessible health care services and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion services for men, women and children of all ages, developing a sustained partnership with patients and practicing in the context of family and community.” These “new docs on the block” have the ability to help alleviate the shortage of primary care physicians being harshly felt throughout the healthcare system. They are working together with physicians to create patient-centered medical homes, to emphasize team-based care and to provide higher quality care to an amplified population of patients.

According to the National Conference of State Legislators, the Affordable Care Act will expanded insurance coverage and access to healthcare to about 32 million new patients by 2019. The Health Resources and Services Administration (HRSA) projects a shortage of 20,400 primary care physicians by 2020. In addition, aging and population growth are projected to account for 81 percent of the change in demand between 2010 and 2020.

HRSA currently designates over 6,200 Health Professional Shortage Areas (HPSAs) for primary care nationwide, in which over 65 million people live. Sixty-seven percent of HPSAs are in rural areas. The ratio of primary care providers to patients in these areas is less than one per 2,000. Physicians alone will not be able to care for this growing population of patients.

The major barrier arises from the residencies that medical students are required to complete before they can become a practicing physician in their field. There remains to be an insufficient amount of Medicare funds to put enough physicians through residency to care for the outstanding number of new patients. Continue Reading »

Contributor: Kirstin Brockenborough
Mutlimedia Health Writing Intern – Emmi Solutions

Kirstin Brockenborough

Kirstin Brockenborough

A couple of weeks ago, I saw this performance art piece that completely blew my mind away. This artist stood stoically under a bright, white light with a large bucket of ice water directly in front of them, while a slow, chilling song repeated “You gotta be hard, you gotta be tough, you gotta be stronger.” The song’s tinny drone was instantly followed by the artist completely submerging their head in ice water for what seemed like forever. As they slowly rose from the freezing ice water, they looked up to the bright light as if asking for guidance. With a couple of deep breaths, the artist submerged their head again for longer that time. I sat there in awe. This artist, whom I’ve never met, perfectly translated into art how I felt when I told my family I was suffering with depression.

“You’ll be okay.”

I received this aloof response after I finally gathered up the courage to acknowledge my depression I had for more than three years to my family. I don’t know what I was expecting from them, but it definitely wasn’t that. A blend of frustration, helplessness and shame washed over me as my mental illness was being promptly ignored. “But I’m not okay,” echoed in my mind.

Growing up, my knowledge about mental health was limited to only the serious mental illnesses, like schizophrenia and bipolar disorder, or what was over-dramatically acted on TV. My conservative family’s vaguely spoken belief of “we don’t have those kinds of problems” or “girl, you’ll get over it” played into the African American community’s stigmatization of mental health. It never occurred to me that other people of color ever had mental illnesses as well. I would eventually come to realize this group of people was bigger than I imagined, but completely invisible.

As a teenager, I didn’t know who to talk to or where to go for help with how I was feeling. I remained in helpless silence and isolation until a couple of years ago when I started attending college, and became more involved in the Chicago community. I volunteered at Camp Butterfly, which was a Chicago-based non-profit organization that provided young girls of African descent a safe space for emotional healing. There, I was finally able to openly discuss my experience of mental illness, and learn right along with the girls that it’s okay to ask for help. Through the organization, I found a slew of helpful online resources and organizations such as the National Alliance of Mental Illness that promoted mental wellness focusing on cultural sensitivity. Continue Reading »

Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions

Elizabeth Ferguson

Elizabeth Ferguson

The English language isn’t well known for allowing speakers to say clearly and concisely what they mean. We don’t have fifty words for snow (though meteorologists will try to convince you otherwise), and anyone who has ever watched a spelling bee or studied for the GRE will tell you we use only a fraction of the words that are at our disposal. Syntax offers no refuge: commas, commonly abused and neglected, have wreaked havoc on authors, journalists and Facebook posters alike.

The point is this: nuanced differences in language can dramatically change the meaning and the tone of what is understood, and nowhere is this more important than in healthcare. Imagine you are an emergency medicine physician attempting to diagnose a person with abdominal pain. You ask them to describe the pain they’re experiencing, knowing that different kinds of pain may indicate very different pathologies. It’s likely that their word choice, body language and expression of discomfort will differ from how you would attempt to describe the same feeling, or how others have described that pain in the past. Also, consider the number of patients that you as a physician will manage that hour, much less that day. Mix in the stress and emotion typically associated with requiring medical attention and how that might affect your patient’s ability to communicate. And of course, don’t forget the multicultural and multilingual nature of the United States—there’s a good chance that your first language isn’t the same as your patient’s. How confident are you that your patient understands what you’re asking, and that you understand what they’re trying to say?

The barriers to effective communication in healthcare settings are significant, but so are the stakes. Traditionally, the healthcare system has placed the responsibility for effective communication on clinicians and patients without offering any real resources with which to navigate such a difficult task. This is beginning to change. More and more, healthcare organizations are taking steps to empower both parties with the tools necessary for comprehension and communication. They are enabling what anthropologists would call “coming to terms,” or building a shared understanding of what certain language means and when to use it. By engaging patients in their own care, educating them about their own conditions and symptoms and offering them meaningful language to use when communicating with clinicians, hospitals are helping to bridge the gap between those receiving and those delivering healthcare. On the other side of the communication equation, clinicians are receiving more training in bedside manner (which includes communication), as well as support from care coordinators and patient advocates, who are specifically trained in effectively translating clinical language into meaningful explanations for patients, and vice versa. Continue Reading »

Contributor: Hailey Merk – Client Services Intern, Emmi Solutions

Hailey Merk

Hailey Merk

If there is one word in the entire English dictionary that my father tells me doesn’t really exist, it’s the word ‘free’. There always seems to be a catch, right? Yet, hospitals around the country have groups of highly motivated and caring people who want to make a difference in healthcare and the patient experience for zero dollar signs in return. This jumps out at me like a 3D pop up advertisement on my computer flashing, “ROI, you won, pick me!”

A study from the Nonprofit and Voluntary Sector Quarterly Journal looked at the cost benefits of volunteer programs and found an average of $6.84 in value from volunteers for every dollar spent—a return on investment of 684%.If hospitals can invest enough time to interview, train and engage a class of volunteers, while concocting new tasks that will transition alongside the shift towards patient and family centered healthcare, major benefits arise .

I have been a student volunteer over the past two and a half years working on mostly clerical tasks, including answering the phone and checking in visitors, or maintenance tasks like cleaning toys in the playroom and organizing shelves. While these tasks are very important, I always found myself completing every task about half way through my shift. Could this remaining hour and a half be time spent working on something other than waiting for the occasional opportunity to talk with a patient? What if hospitals trained volunteers on patient experience metrics and patient engagement technology so their efforts could be bettered focused on really improving a patient’s experience as well as their ability to take an active role in their care in and outside of the hospital?

A huge aspect of patient engagement is messaging and communicating with patients to ensure that they are making informed decisions and are becoming more involved in their healthcare. Patient engagement technology is becoming a major tool to assist healthcare professionals to close the gaps in health literacy and communication between providers and patients. Volunteers can attend a training session about the technology, and then transfer their knowledge directly to patients. Volunteers can take advantage of a refurbished laptop or tablet and bring it to patients to show them, step by step, how to use the technology. They can be responsible for giving the patients printed instructions as well as verbally messaging to the patient about the tool to avoid any confusion. Continue Reading »

Contributor: Courtney Hummel – Senior Client Services Specialist, Emmi Solutions

Courtney Hummel

Courtney Hummel

The only time I visit museums is when visitors come into town. At that point, I can don my hostess cap and show my “they-aren’t-from-around-here” tourist friends around town. Secretly (don’t tell anyone), I’m giddily enjoying all the sights and sounds while pretending that I know what I’m talking about.

My most recent adventure took me to a museum exhibit about Walt Disney, his impact on the film industry, and his incredible insight into, quite simply, what makes people happy. Imagineering, anyone? Disney had guest service — never customer, always guest — down to an art, from the spotless streets, to his special brand of “assertive friendliness,” and even the psychology behind waiting in line. People visit the happiest place on earth and spend 30, 45, 60 minutes for a 2 minute ride, all the while leaving happier than they started.

While the end result of an encounter with the American healthcare system isn’t as exhilarating as a trip down Space Mountain, we experience similar guests – guests, not patients – playing the waiting game. Whether it’s waiting in the ER to be triaged, calling for a primary care appointment and finding no openings for 5 days, or hitting the refresh button on our patient portal (surely my lab tests were uploaded today!), the passivity of waiting is a frustrating, unsatisfying experience.

With patient satisfaction scores tied to CMS reimbursements, healthcare institutions are looking at any additional tools to improve the patient experience. One of these targets, especially in areas such as emergency rooms, is reducing wait times. This is quite the challenge, considering patient satisfaction is not a product of the clinical experience, but a result of perception. For example, patients vastly overestimate the objective length of wait times, often by up to 36%.

There are a few important factors to remember when considering the time a patient is waiting.

1. Occupied time feels shorter than unoccupied time. Executives at a Houston airport were experiencing an inordinate amount of patient complaints about the wait time in baggage claim. After throughput analysis, they discovered that the arrival gate was only one minute from the baggage claim area, but it took seven additional minutes for the bags to arrive. The solution? Reroute the bags to the carousel furthest from the arrival gate. The result? Zero complaints. By filling time with an activity, whether that is walking to baggage claim at the airport or watching a program that explains the triage process in the Emergency Room, waiting time can magically disappear. Continue Reading »

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