According to a recent report from WVXU in Cincinnati, the “oldest old,” or those 85 years of age or older, sometimes have difficulty “accepting dying is a natural part of life.”

When it comes to treatment decisions, the oldest old also struggle to decide when to pursue treatment, and when it will possibly be safer and more comfortable to live without treatment.

However, these challenging health decisions are not limited to just “the oldest old.” In fact, anyone at any age can have difficulty fully accepting dying is a natural part of life.

In most cases, we’re too busy living.

Yet, things can happen in our lives unexpectedly and, when it comes to our health, we need to be prepared to make the important decisions – and if we can’t make the decisions ourselves, we need someone to speak on our behalf.

So it’s essential to communicate about our wishes with loved ones. In fact, today is National Healthcare Decisions Day – a day “to inspire, educate & empower the public & providers about the importance of advance care planning.”

And we understand what you might be feeling because we feel it ourselves – talking about these kinds of decisions can be really unsettling. No one necessarily enjoys talking about how their life will end, but having conversations about advanced care planning has many benefits.

For example, if something were to happen in your life where you were unable to make your own health decisions, having an advanced care plan ensures your wishes will be carried out as you want them to.

Additionally, by having your health decisions prepared in advance, you help reduce an emotional weight on your loved ones. Trying to determine what you would want can create a lot of stress for your family. Often loved ones feel guilty, worrying that they may make the wrong decision and, in the nature of people, your loved ones may have differing opinions about what the “right” decision is for you. Instead of spending time together or with you during a difficult time, they may spend time fighting about what choice to make. Continue Reading »

You’ve heard it often in conversation, online or at presentations – healthcare is changing.

The concept is not new, and while it is a small phrase, it encapsulates numerous deviations from our norm.

For some organizations, “healthcare is changing” represents a need to focus on federal reimbursement opportunities.

For others, it means determining how to reach more patients with fewer resources.

Whatever “healthcare is changing” means for your organization, you need effective ways of adapting for what’s ahead.

Today, we’re highlighting a very specific change in the industry, one that is of consistent concern – the physician shortage.

We can talk about improving patient engagement and quality of care, but ultimately it depends on having the staff available to do so. So how concerned should we be about the physician shortage?

Well, according to the Association of American Medical Colleges (AAMC), the United States will likely have a shortage of approximately 92,000 physicians by 2020, and that shortage is equally distributed among primary care and medical specialties. This shortage is also anticipated despite the fact that AAMC also predicts a 30% increase in medical school enrollment between 2002 and 2017.

So what’s the cause of the deficiency in our number of doctors?

As stated in The New York Times, “Hospitals, doctors and med students usually give the same explanation: Congress is too stingy.”

In 1997, the Balanced Budget Act capped federally funded residency positions for first year trainees at 26,000. With medical school enrollment increasing, the 26,000 available slots are not enough to provide training for all those who will graduate.

Additionally, as Gail Wilensky, a health economist and co-chairwoman of the Institute of Medicine’s Committee on Governance and Financing of Graduate Medical Education, shared with the Times, physician shortage may be due, in part, to the cost placed on individual health organizations. Continue Reading »

Guest Blogger: Cathy Koperek

Cathy Koperek

Cathy Koperek

Your patient comes in for a re-check on an issue. Everything looks good – the virus or whatever relevant issue has cleared up and it looks like she’s well on the road to recovery.

And then she says it. “I’m not sure it’s related to this or not, but I’ve been losing my hair.” Now, it could be anything, such as not sleeping well, or it’s simply breaking out, or any of the other many vague issues people deal with. Let’s use hair loss as an example for right now.

You know that medically there is almost no chance that her hair loss is related to the original complaint. You know that she is of an age where hair loss should not be such a surprise. You also know that her hair looks fine.

So, what do you say?

Here are three phrases I can guarantee you that woman does not want to hear:

  1. It’s probably hormones
  2. Stress can do that
  3. I don’t see anything wrong

She might be nodding her head, hands folded in her lap. Maybe there’s even a hint of a smile on her face. But, you know what?

She is probably struggling with anger and anxiety inside.

When patients reveal something to you, they are confiding in you. So ask yourself what you would say if your friend confided to you the same thing. Your responses would probably include:

  1. It’s probably hormones
  2. Stress can do that
  3. I don’t see anything wrong

And, that friend might just reach out and give you a verbal lashing. She’d probably say something like “Thanks a lot. I wouldn’t have brought it up if I wasn’t worried about it. And you tell me it’s stress? Hormones? Look, right here, look at this bare patch!”

So you try to explain that it really could be stress or hormones and you really are trying to help. And, honest, your hair looks fine. I like the new color.

Your friend and your patient share the same complaint (besides a loss of precious hair) and their concerns have been dismissed with clichés. Continue Reading »

On Tuesday, we discussed how challenging it can be to drive patient action and highlighted four approaches that are used often by clinicians to incentivize behavior change.

However, those approaches typically produce poor results. So, what else can providers do?

Well, according to a recent article in The Wall Street Journal, the answer may be to utilize “PAM,” or the Patient Activation Measure.

A system licensed by Insignia Health, PAM assesses how engaged patients are in their own health by scoring their responses to 13 statements. For example, PAM may offer the statement, “I am confident that I can tell my doctor my concerns.” A patient will then respond to the statement indicating how strongly they feel it applies to their own health and care.

Then, PAM calculates a final score between 0 and 100 and divides patients into four categories of action – those that are poorly activated to those who take a large amount of action in their health.

This information is helpful in a variety of ways.

First, the scores can instill a sense of patient accountability – poor scores can incentivize patients to take more action in their health.

Secondly, positive scores can help patients feel confident about their ability to change their behavior. Knowing you’re doing well can be encouragement to continue the good work.

Blog-Graphic-(04.03.14)

Additionally, PAM can be immensely beneficial to providers, helping them to improve their own patient engagement strategies. Continue Reading »

As the healthcare industry moves from fee-for-service to fee-for-value, there is increased emphasis on population health management.

How do you improve the health of your entire patient population, not just those who are severely ill?

An article in The New York Times not only highlights how difficult it is to change patient behavior, but it explains the challenges associated with motivating an extremely at-risk patient population – “the unworried unwell.”

For example, patients with diabetes can often feel negative side effects when they do not take proper care of themselves or follow their doctor-prescribed instructions. Yet, a patient with high blood pressure or high cholesterol may feel completely fine, and therefore is less incentivized to change behavior even though the condition could exacerbate into something even more serious.

So how do clinicians persuade patients to take their conditions more seriously?

Well, according to the article, there are 4 common approaches (all often producing subpar results):

1. The Reasoned Numerical Approach:
The approach often sounds like this: “20 percent of people with your condition who do not manage it will develop X.” While it may sound credible or persuasive, the typical patient has difficulty understanding health information, especially information expressed with mathematical terminology.

2. The In-Your-Face Approach:
You’ve seen the anti-tobacco commercials – the ones with thousands of adults falling to the ground in resemblance of those who die from tobacco usage or the one with a young adult giving her skin as “compensation” for her pack of cigarettes. (Gross). While it attempts to convey something true, this approach is often so off-putting that the context overshadows the message.

Blog-Graphic-(04.01.14)

3. The “It’s Your Funeral” Approach:
This is one of the most parental approaches, or maybe the “relationship gone bad.” We’ve all heard it before, maybe from parents, ex-signficant others, teachers, etc. – “Fine. If you’re not willing to do the work, it’s your problem.” It rarely works, even coming from someone you love, and it’s only bound to put unneeded stress on your provider-patient relationship. Continue Reading »

While we talk often of patients needing to engage themselves in their own care, it is just as essential for people to take active roles in their health prior to ever becoming a patient.

How essential?

Take a look at these stats, released discussed by Becker’s Hospital Review and the CDC’s National Center for Health Statistics’ report “Health, United States, 2012.”

1. Percent of population with fair or poor health:

  • All ages — 10.4 percent
  • 65 years and older — 24.7 percent

2. Percent of population with heart disease:

  • 18 years and over — 11.6 percent
  • 65 years and over — 30.5 percent

3. Percent of population with cancer:

  • 18 years and over — 6.3 percent
  • 65 years and over — 18.5 percent

Blog-Graphic-(03.25.14)

4. Percent of population with hypertension:

  • 20 years and over — 31.9 percent

5. Percent of population with high cholesterol:

  • 20 years and over — 13.6 percent

6. Percent of population categorized as obese:

  • 20 years and over — 35.9 percent

7. Percent of population who smoke cigarettes:

  • 18 years and over —19 percent

What are you doing to take charge of your health and change these statistics?

Not every doctor has an experience like Holbrook Kohrt.

With no family history of hemophilia, he was born a hemophiliac, an individual whose blood does not clot as it should, creating extreme difficulty in controlling hemorrhages even after minor injuries.

In this Q&A with The New York Times, he speaks of his own experience in the healthcare system and how his struggle led to his desire to become a hematologist at Stanford University.

He shares insight for providers and patients alike, expressing that you don’t need to have rare diseases to be inspired about health as he was.

For example, he speaks of the importance of understanding care from the patient perspective in order to deliver it effectively.

He talks about building a special relationship with patients by emotionally relating to their experience, despite medical training that often says to disassociate yourself from personal emotion.

And for patients who struggle with behavior changes, things they need to do to live well and stay healthy, he speaks of their shared bravery saying: “Any behavior or pattern that you have to do, that you need to do, that you don’t really have a choice to do, people who live through that experience, they realize that the only way [to live with that] is to persist.”

Click the image below to hear more about his story.

holbrook

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