Category Archives: Patients
Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.
Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.
Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging. This balance can be particularly difficult for students and new clinicians.
This is part of the November 2013 issue of Sharing Nursing's Knowledge.
“Being the best is not measured by the number of accolades, positions that you hold, or amount of wealth you accumulate. When you have reached a point on your leadership journey where you can be of assistance and influence a larger sphere of individuals, organizations and society, then you are on the path to being the best.”
-- Linda Burnes Bolton, DrPH, RN, FAAN, chief nursing officer, Cedars-Sinai Medical Center in Los Angeles and trustee, Robert Wood Johnson Foundation, Accelerate Your Career in Nursing: A Guide to Professional Advancement and Recognition, 2013
“I worked closely with a nurse practitioner. We co-managed very complicated patients over many years. This colleague knew when someone needed to be seen to avoid an emergency room visit, to adjust an essential medication or just for reassurance. We trusted each other’s opinion and respected our own unique abilities. Being part of a team increased quality, reduced cost, and definitely improved the experience of our patients. I am sure many of my physician colleagues around the state have had similar experiences … The Green Mountain Care Board‘s inclusion of a highly qualified nurse is another indication of our commitment to respecting the abilities of all health care providers and fostering innovation.”
-- Allan Ramsay, MD, Green Mountain Care Board, Nursing in the Era of Vermont Health Care Reform, VTDigger.org, October 29, 2013
This is part of the October 2013 issue of Sharing Nursing's Knowledge.
“It’s not like it’s an Olympic medal or anything. But it’s definitely a huge milestone in my life … Ideally, I want to work in a hospital setting, maybe in acute care or in a trauma unit. It’s that whole team approach to medicine, nurses and doctors working together, that I find attractive. I think some of being a hockey captain, being on a team, asked to be a leader, plays into all that. It’s where I think I can help people most.”
-- Jim Ennis, Ex-Hockey Player Starts New Life as Nurse, Boston Globe, September 22, 2013
“Recently, I cared for two patients who touched me so deeply it was impossible to maintain a professional distance. My grandfather had recently passed away, and both of these men reminded me of him … Watching them leave was like letting go of my grandfather again, but they also gave me the gifts of laughter and reminiscence, right when I needed them most. I know that, ultimately, I am still just the nurse, and they are still just my patients. But I think it’s better for both the patients and myself if we both sometimes allow ourselves to feel something more than a professional bond. Nurses and patients move in and out of each others’ lives so quickly, but we are nonetheless changed by every encounter. I became a nurse because I want to care for people and make a difference. Being touched in return is an added bonus.”
-- Sarah Horstmann, RN, When Nurses Bond With Their Patients, New York Times Well Blog, September 13, 2013
Health Care Providers Shouldn’t Hit the Snooze Button When It Comes to Asking Their Patients About Sleep
Aric A. Prather, PhD, is an assistant professor of psychiatry at the University of California, San Francisco and an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program.
Heart disease accounts for one in every four deaths in the United States—600,000 deaths per year. Prevention and treatment regimens for heart disease include important changes in lifestyle, centering primarily on alterations to diet and physical activity. Interestingly, sleep is rarely part of this discussion.
This is alarming given the growing evidence from large-scale population studies and laboratory-based experiments that demonstrate that sleep plays a larger role in heart health than originally appreciated by the medical community. For example, in a 2003 study, women with established coronary heart disease who reported poor sleep quality were more than 2.5 times more likely to go on to experience a cardiac event than good quality sleepers. Nevertheless, when it comes to asking patients about their sleep, health care providers routinely hit the snooze button.
In an effort to raise the profile of sleep as a risk factor for cardiovascular disease (CVD), my work has focused on investigating the links between sleep and the biological pathways implicated in CVD development and progression. Said another way, much of my research focuses on how sleep disturbance gets under the skin.
Human Capital News Roundup: Asthma education, sleep deprivation in hospitals, nurses on boards, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
The dark blue dye used to identify lacerations and tears on the skin of rape victims doesn’t show up as well on dark skin, Phys.org reports, which means injuries that could move cases through the criminal justice system may not be documented. RWJF Nurse Faculty Scholars alumna Kathryn Laughon, PhD, RN, FAAN, is working to create a fluorescent dye that will show up on all skin types. WTVR-TV (Richmond, Va.) and Newsplex.com (Charlottesville, Va.) also report on her work.
The Chicago Tribune [subscription required] reports on a program that is teaching children how to control their asthma, how to recognize common triggers for asthma attacks, and how they can educate their communities about the disease. Ruchi S. Gupta, MD, MPH, an alumna of the RWJF Physician Faculty Scholars program, who spearheaded the asthma education program, said: “These kids didn't know they had a voice, (that) they could actually use it to make a change… My dream is to have a map of Chicago and you click on a neighborhood and you can see these videos and tools the students have made in each neighborhood.” Central Kentucky News also reported the story. Read a post Gupta wrote for the RWJF Human Capital Blog about her research on food allergies.
“As a profession, we feel passionate about protecting the safety and quality of our patients [by] serving on committees and boards,” RWJF Senior Adviser for Nursing Susan Hassmiller, PhD, RN, FAAN, told AMN Healthcare about nurses serving as board members or in other leadership positions. “That means you have to raise your hand and say ‘I’ll do it.’ It’s a time commitment.”
Anjali Gopalan, MD, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholar in residence at the University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
Propelled by a highly publicized study funded by a $1.4 million grant from the Robert Wood Johnson Foundation, OpenNotes software has created quite a stir in the world of health care reform since 2010. Its high-profile testing paralleled the rise of the Affordable Care Act and the new emphasis that law puts on the computerization of virtually every part of medicine, including the doctor-patient relationship itself.
OpenNotes is a digital tool with which a physician takes and stores the notes of every encounter with a patient. The new aspect of OpenNotes that has drawn so much attention in the press and professional venues like the AcademyHealth National Health Policy Conference is its ability to provide patients instant access to everything the doctor writes about them.
Subject of Much Debate
The question of how this new kind of doctor-patient information collaboration might ultimately affect either party remains the subject of much debate. The conference session that focused on it was entitled "Stirring It Up: Putting Patients in the Middle" and featured Tom Delbanco, MD, the Harvard Medical School professor who is leading the national OpenNotes development and implementation effort.
Jeff Niederdeppe, PhD, is an assistant professor of communication at Cornell University and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of Wisconsin.
For the past 10 years or so, my colleagues and I have been studying how Americans make sense of public information about the causes of cancer and ways to prevent it. This has brought both good and bad news.
First the bad (and perhaps not surprising) news: many Americans are overloaded with information about cancer prevention and feel powerless about what they can do to prevent it. According to national surveys, one in four say there’s not much a person can do to reduce their risk of cancer, half feel that almost everything causes cancer, and three in four think there are too many recommendations to know which ones to follow. People who hold these beliefs are less likely than those who do not to engage in behaviors that we know reduce their risk of cancer – avoiding smoking and sunburn, eating a diet rich with fruits and vegetables, exercising regularly, and maintaining a healthy weight. These beliefs thus appear to have troubling consequences for broader efforts to reduce the rate of cancer in the U.S. through primary prevention.
In many ways, these feelings are understandable – it IS confusing. Cancer is not a single disease, but hundreds of them affecting different organs in the body, with different causes, different tests to screen for them, different treatments, and different prognoses. By some estimates, half of all cancer cases have an unknown cause. Cancer research moves slowly and incrementally, but increasingly publicly – one study might suggest that coffee causes cancer, while another points to its preventive potential. Science requires a back-and-forth between scientists as they sort out what findings hold up and which ones prove only preliminary. This process is absolutely necessary, but can offer a false sense of hope or opportunity if appropriate caveats aren’t offered in early stages of this work, or if preliminary results are publicized widely through the media.
Following a study that found serious gaps in advance care planning for decisions about serious illness, Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholar Rebecca L. Sudore, MD, has launched an online resource to help patients prepare to make complex medical decisions. Sudore, who led the study, saw a need for an easy-to-use tool , beyond an advance directive form, that could help prepare patients to identify what is important to them in life, communicate their wishes with others, and make informed medical decisions.
PrepareForYourCare.org is a free, easy-to-use online resource that guides patients through all the steps of advance care planning, and incorporates content directly from Sudore’s study. It is written at a fifth-grade reading level, includes voice-overs of all text and large fonts for the visually impaired and closed captioning for the hearing impaired.
More importantly, PREPARE shows people, through videos and a step-by-step process, how to have the conversation and make informed medical decisions.
Andrea Wallace, PhD, RN, is an assistant professor at the University of Iowa College of Nursing and a Robert Wood Johnson Foundation Nurse Faculty Scholar.
Patients live in communities that offer support and include influences that are outside the walls of clinical settings. While this is not a new revelation, I have often had to remind myself and the students I teach that, as health care providers, we witness only a very small part of patients’ lives, generally at a time when they are most removed from their experience of daily living.
"I cringe to think of how many of my adult patients I’ve asked to adopt a complex medication schedule for their diabetes, all the while suspecting they may have limited literacy skills"
We must remain continually aware of patients’ personal and financial resources when planning care. But it was not until recently that I became incredibly taken with the idea that, for many patients living with chronic illness, it’s those who help patients care for themselves—the daughter picking up medications, the neighbor driving to appointments, the spouse doing shopping – who may make the difference between successfully and unsuccessfully coping with what can be incredibly complex self-management regimens.
Americans’ visits to physicians had become less frequent in recent years, at least in part because of patients’ financial concerns. But they’re apparently beginning to pick up again. American Medical News reports that recent data from insurers, consultants and analysts shows physician visit volume has risen, and that patients are reporting fewer problems affording care.
Among the encouraging data points:
- A June research note from analyst Charles Boorady of Citigroup Investment Research shows physician visit volume rose by 4.8 percent over the second quarter of 2012. The number is good news on its own, but the trend line it represents may be just as telling: The comparable quarter of 2011 saw an 8.9 percent decline.
- In a March Gallup poll, 80.9 percent of respondents said they had no problem affording needed health care. Though this number is slightly lower than in February 2011, it is up from the 77.7 percent who responded similarly when the recession hit in late 2008.
- Data from Truven Health Analytics, formerly Thomson Reuters Healthcare, finds that visits to family doctors, internists, ob-gyns and pediatricians rose in May and June.
Though an easing of financial pressures could be behind the rising number of patient visits to physicians’ offices, the American Medical News story notes that some experts think the Affordable Care Act may also be playing a part: Now that many preventive services are covered free of charge, more patients may be seeking out these services.
What do you think? What’s behind the trend in increased physician visits? Is it due to patients’ finances, health reform, both or neither? Register below to leave a comment.