WE WANT WHAT WE WANT!

Here are some new statistics from Deloitte's 2008 Survey of Health Care Consumers:

• 93 percent of consumers say they’re not adequately prepared for future health care costs;
• 79 percent of consumers believe health care will be an important issue in the 2008 election;
• 46 percent described it as one of the top three issues that will affect their vote;
• 34 percent say they would use a retail clinic; 16 percent already have;
• 39 percent say they'd go abroad for treatment if quality was comparable and the cost was cut in half;
• 66 percent either strongly support (36 percent) or might support (30 percent) state-mandated health insurance;
  
• 60 percent want physicians to provide online access to medical records and test results, and online appointment scheduling;
• 1 in 4 say they would pay more for the service;
• 1 in 3 consumers say they want more holistic/alternative therapies in their treatment program;
• 3 in 4 consumers want expanded use of in-home monitoring devices and online tools that would reduce need for visits and allow individuals to be more active in their care;
• 66 percent strongly favor or lean toward state-mandated health insurance;
• 84 percent prefer generics to name-brand drugs;
• 29 percent support a tax increase to help cover the uninsured; another 37 percent say they would consider a tax hike;
• Only 52 percent of consumers say they understand their insurance coverage;
• 1 in 4 consumers maintain a personal health record.
  

According to Paul Keckley, executive director of the Deloitte Center for Health Solutions and co-director of the study, "American's no longer see themselves only as patients, but as consumers who want to take control of their health care,"

I hope so...

HOSPITALIZATION AND YOUR CREDIT SCORE

Last night, while relaxing, I read my monthly (June, 2008) Costco newsletter (The Costco Connection) in which I found the following headline, "Credit Check Could Make You Ill." In it, author and well known consumer credit advisor, David Horowitz, said the following...

"Many hospitals now investigate patient’s personal credit reports to figure out how likely they are to pay their bills. By accessing these credit reports, hospitals are peering at personal lines of credit, payment histories and debts. They say this helps identify which patients to pursue actively for payment because they can, in fact, afford to pay, which helps to minimize losses. They also claim it allows them to quickly identify which patients are eligible for charity care or assistance programs. If a hospital requests the information, be sure to ask them why and whether it’s absolutely necessary. Also, if a problem arises, make sure you ask how the hospital came by the information. By law, hospitals aren’t allowed to turn away patients in an emergency. And public hospitals (as opposed to private hospitals) are often required to give non-emergency care if it is considered medically necessary."

Guess what? I stopped relaxing and felt my blood pressure begin to rise...

I have often wondered why the hospitals in which my husband was treated were so incredibly aggressive in their debt collection practices when they had received virtually full pay from our insurance company on $1.75 million in claims. Finally, here is the answer! They came after us because we could afford to pay the difference!

• Another punishment imposed on working families who pay their bills and use money responsibly.
• Another example of rewarding poor behavior (irresponsible credit users) and punishing good behavior (responsible credit users).

I wish I could say this is atypical but, in my experience, it is not. Take heed, hospital-users. And, do you still think that healthcare is not a business???!?

THE FINAL SAY

In my business practice, I often find myself coaching individuals who insist on having "the final say." They are committed to the appearance and/or actuality of being in charge and often run their own company. Few, if any, apply this commitment to their personal life as it relates to end-of-life planning, even though this would preserve their right to have "the [FINAL] final say!"

Each year, we honor April 16th as National Healthcare Decisions Day. Healthcare decision documents are known by many names including:
• Durable Medical Power of Attorney - states that a designated person has the legal right to make healthcare decisions for me, should I become incapacitated;
• Living Will - specifies that extraordinary efforts not be used to prolong my life should I become terminally ill or unable to regain a meaningful quality of life;
• Power of Attorney - specifies the legal right to make non medical-related decisions for an incapacitated person, are necessary;
• Advanced Directives - a combination of the above documents;
• HIPPA Release Form - states that I understand the materials or data I am requesting will be released without protection by Federal Privacy Protection Regulations and includes a "hold harmless" statement.

I always send an email to my colleagues and friends on this day asking the following questions:
• Do you have an executed Durable Medical Power of Attorney?
• How many copies do you have and where are they stored?
• Who else has a copy?
• Are you confident your appointed healthcare agent will act as you wish rather than as they wish?
• Have you discussed your end-of-life wishes with this individual?
• Do you have a Living Will?
• Have you specifically addressed the issue of pain management as we must assume the pain stimulus is still present? (reference Oxford Textbook of Palliative Medicine, 2nd ed. 1999, pages 982-989)
• How many copies do you have and where are they stored?
• Who else has a copy?
• Does your primary care physician have a copy in your file?
• Does your primary care physician know how to reach your appointed healthcare agent?
• Have you discussed your end-of-life wishes with your primary care physician?
• Have you discussed end-of-life wishes with your family and loved ones?
• Do you have an executed HIPPA Release Form?
• How many copies do you have and where are they stored?
• If you are a DNR ("Do Not Resuscitate"), is your form in order, executed by your doctor and posted in a prominent place in your home? (the refrigerator door is commonly used)

These are not pleasant or easy issues to confront and there are no "right" answers, just "your" answers.

No one wants to believe anything bad could happen to them, the very issue that confronted the spouse and parents of Terri Schiavo, who at age 27, suffered a cardiac arrest, that lead to brain damage due to lack of oxygen. Her case went to the Supreme Court because she lacked these documents. Regardless of what course of action you believe should have occurred, the fact remains that this painful experience could have been totally avoided by her family and the county had she executed these two documents. Most importantly, all would have known that what was done was what she wanted.

Why do I feel so passionate about this subject? Although my husband survived catastrophic medical events during a 7+ month hospital stay, I entered his medical nightmare as "just a spouse," not as a person who had Durable Medical Power of Attorney. Talk about a case of the cobbler's children not having shoes! I was married to an attorney, who refused to deal with legal issues such as a Durable Medical Power of Attorney and a Living Will because "it was too upsetting to think about them."

It has been my experience that you run into two types of healthcare providers—
• those who appreciate your knowledge and wish to partner with you and
• those who do not.

The real need for these documents occurs when you deal with the latter as I did in each of the four hospitals in which my husband was treated. Keep in mind that HIPAA privacy laws make it extremely difficult, if not impossible, for you to access patient information as an advocate without a Durable Medical Power of Attorney. When someone we care about is hospitalized, we are under enough stress without having to take on this additional burden.

DO THIS NOW! Don't put it off! If you need copies of these documents, here are three sources:

1. go to http://www.uslivingwillregistry.com/forms.shtm
2. go to a local hospital and ask the Legal or Patient Advocacy office for state-compliant forms;
3. visit http://www.caringinfo.org/stateaddownload and download free state-specific advanced directives.

A quote by Roy Walsh, psychiatry professor interviewed in The Search For Meaning by Phillip L. Berman, may explain how we continue to feed our denial. "You can see that basically our lives are, to a large extent, spent in avoiding confrontation with ourselves. And then you can begin to make sense of the enormous amount of our culture's daily activities, which attempt to distract us from ourselves, from deep reflection, from deep thinking, from existential confrontation. There's a wonderful phrase by the philosopher Kierkegaard, 'tranquilization by the trivial.' And I think our culture has mastered this better than any culture in history, simply because we have the wealth and means to do so."

Regardless of our cultural conditioning, I believe avoidance of this subject is also a direct result of fear:
• fear of the unknown;
• fear of talking about death;
• fear of the act of death;
• fear of reactions to our conversations

and on and on. Christian Nestell Bovee states, "We fear things in proportion to our ignorance of them." If true, then merely having these conversations and making these decisions should calm some of our fear. Not only are you doing yourself a service, you are sparing your family the agony of one of life's greatest and most difficult decisions.

You are also ensuring that you have "the [FINAL] final say!"

ON YOWN OWN BEHALF...

What five tips would you have for women to get the best possible health care possible and feel empowered with doctors?

1. Recognize that medicine is considered BIG business today and treat it as such. If you hire a contractor to do something for you in your home, you are paying their bill, directing their attention to your need(s) and requiring them to satisfy you in order to be paid. As such, you are the boss of that contractor. The same goes for a medical provider, whether that provider is a doctor, nurse, hospital, care giver or care facility. You are their boss. They work for you because you pay the bill. Therefore, they have an obligation to “satisfy” you regarding how you are treated. Unlike a contractor (for example, a plumber), they cannot always guarantee the outcome. But they can and should treat you in a way that enables you to learn what they are proposing and why. You have the right to expect good treatment. Anything less, dishonors you.

2. Do your homework! Recognize and give yourself permission to not understand everything you read. Anything you take away from your research gives you greater credibility. Research your:
• disease or condition;
• doctor(s);
• hospital and/or care facility;
• medication(s);
• recommended treatments and side effects.
Many times our powerless feelings are directly related to how much we know. By doing your homework, you will be more comfortable asking questions and the medical community will know they have an educated consumer and treat you as such. If they do not, find another care provider. You have a right to get answers to your questions. If your plumber refused to tell you what they were going to do, why and how much it would cost, wouldn’t you look for another plumber?

3. Propose a partnership with your doctor and tell them what that means to you. They are (or should be) practicing “patient-centered” medicine. That means that, as a patient, we must understand what is going on and participate in decision making. We can no longer afford to be passive and turn these decisions over to another. There are too many problems in and complications with healthcare. If your doctor:
• does not have time for questions;
• cannot or will not explain about your -
− disease or condition;
− medication(s);
− recommended treatments and side effects and/or
will not discuss
− his/her experience in treating it;
− why s/he is recommending a particular hospital and/or care facility,
find another doctor. You have a right to understand the proposed treatment.

4. Be prepared to explain all your present medical conditions and identify all your medications when you interact with the healthcare community. I recommend you create and carry with you at all times a document that lists the following:
• contact information;
• emergency contact and his/her information;
• known allergies;
• current medications, doses and frequency;
• current medical conditions;
• primary care physician and contact information;
• preferred hospital for emergency transport;
• insurance information;
• identify the existence of a Durable Medical Power of Attorney and/or Living Will and/or Advanced Directives.
If your purse looks like mine, you may wonder how all this will fit! You can shrink this information down to an 8-point font and fit it on a portion of a single piece of 8-1/2 X 11 inch paper. Place it where emergency personnel will find it easily and keep it current! When you visit a doctor, simply remove it from your purse and hand it to the intake person. You can’t believe how many, “WOW’s!” I’ve received using this procedure. Those “WOW’s” tend to open doors with doctors because, you are treating them as a professional by being medically professional yourself.

5. Be respectful and firm. The doctors with whom you are dealing have made a lot of sacrifices to appear in front of you today. They are well educated and it is this very education and knowledge that you seek. If you do not get an answer to your questions or receive an answer you do not understand, ask the doctor to explain it again and again until you understand. Many doctors are not used to this insistence and we have to train them. In many ways, this is the same method we use with our children. If our children do not do what we want, we encourage and/or consequent them until they do. If we allow doctors to avoid answering our questions, we are reinforcing bad behavior as well as our own poor self-esteem.

The saying, “Do onto others as you would have them do onto you” fits both sides of the patient/doctor interaction. Everything recommended here requires that you step into your power and take action. When we take action, we feel less anxious and begin to know that we have done everything we can on our own behalf. That’s called, “Living.”

Martha Graham, one of the best-known teachers and choreographers of modern dance, says it like this…
There is vitality, a life force, a quickening
That is translated through you into action,
And because there is only one of you in all time,
This expression is unique.

And if you block it,
It will never exist through any other medium
And be lost.
The world will not have it.
It is not your business to determine how good it is:
Nor how valuable it is: nor how it compares with other expressions.
It is your business to keep it yours clearly and directly,
To keep the channel open.

You do not even have to believe in yourself or your work.
You have to keep open and aware directly
To the urges that motivate you.

Let them motivate you on behalf of your own health!


© Jari Holland Buck - 2008, On Your Own Behalf