Life is Fragile, Love is Not

I’ve been following Henry’s Challenge, and Dr. Smak, blogs written by the parents of Henry Keating Scheck, a four year old with Medulloblastoma. 

Henry’s parents have allowed readers a personal and eloquent glimpse into their lives at a time when most would not have the courage to do so. 

It was with both sadness and relief that I read this week that Henry’s battle has come to a close.  My thoughts are with the Scheck family.

What Not to Say at Work (or maybe anyplace else)

 CNN Career Builder recently posted a list of “Worst Things to Say at Work.”  Among them the infamous, “that’s not my job.”  So what’s on your list of words and phrases not to be uttered in the workplace?  Here are a few I would include:

  • Vulgarity.  Whether listeners find it offensive or not, most will acknowledge that over time frequent use diminishes their respect for the speaker. 
  • Endearments.  Honey, sweetie, etc.  Unless you work with your significant other, avoid terms of endearment when addressing your co-workers (or customers).
  • Endless Complaints.  “No one else works as hard as I do. How can I be expected to accomplish all this?  The boss is a moron.”  We all need to vent and complain from time to time, but it’s draining to be around someone who complains ad nauseam.
  • Self-aggrandizing.  “I own, I have, I earned, I accomplished.”  It’s appropriate to take credit for your professional accomplishments, but co-workers will not be suitably impressed if your conversation continually centers around a litany of self-congratulations. 

Those top my list of things better left unsaid, any others top yours?

The Blog That Ate Manhattan Snacks on This Week’s Grand Rounds

Peggy is a physician who loves to cook – which I suspect must be unusual.  After all, how many docs actually take time for a little “cheffery” on the side?   Not only does she cook, but she blogs – another time-consuming activity.  A lady of many talents and much energy! 

At any rate, this week’s edition of Grand Rounds, the best posts from around the medical blogosphere, is hosted over at The Blog that Ate Manhattan.  Stop over for a bite.

Grand Rounds

Healing Conversations

“Your child was harmed while under my care, by a mistake that I made, and I am so sorry.” 

How would it feel to hear those words?  How would it feel to say those words?  How would you help coach a healthcare professional who was about to face that conversation?

I had the opportunity to explore all of those roles recently and let me assure you, none of them were comfortable or easy.  And in my case the scenes were scripted, not real.  

A few weeks ago I participated in a week-long training session on conflict management skills for health care professionals run by Carole Houk, JD, LLM, principle of Carole Houk International.  After several days of in-depth training and discussion around building an environment that supports transparency in healthcare, members of the group were each given different roles to play in various case scenarios.  Each player received only the facts of the case that were known to their character.

At one point I played a grieving parent; I was surprised to find that it was difficult to listen to and comprehend the information that was being shared by the “doctor” in the scene. I sat there thinking about all the things I “knew” about the child I’d just lost. Just playing that difficult role gave me added compassion for real parents, real patients, and real physicians undertaking the challenging role of disclosure.  

We had been extensively coached by Carole and her assistant, Leigh Ana Amerson, prior to these role play sessions.  Among other points we were reminded to use the patient’s personal name. Don’t refer to them as the patient, your child, your husband, etc.  Using the patient’s personal name reassures their loved ones that you see them as a real person, not just another case. 

One of the repeated reminders we heard was the need to allow the person receiving the disclosure time to express their feelings and to talk about their loved one.  Speaking for myself, I know that I nodded and agreed, all the while thinking that was pretty much a “no brainer.”  However, in each scene we played, those of us given the role of disclosing, or coaching the discloser, were so anxious to “help” that we usually jumped in with some information or offer long before we’d allowed sufficient time for the patient or family members to have their say.  Listening to and acknowledging painful emotions is distressing.  

It was excellent training for a difficult skill.  Those of us who attended are continuing to practice, realizing that disclosure and conflict resolution done well require life-long learning.  

   

Carole and Leigh Ana

Grand Rounds is Hosted by Emergiblog

Kim from Emergiblog (one of my favorite medical bloggers) hosts this week’s edition of Grand Rounds, the best of the medical blogosphere. Posts are woven around a movie called Napolean Dynamite, which according to Kim is “pretty much the coolest movie ever made. ”  I’m going to have to take her word on that one, can’t say I’ve seen it.

Stop by Emergiblog and check out this week’s compilation of medical insights. http://www.emergiblog.com/2009/02/its-grand-rounds-what-do-you-think-gosh.html

 Grand Rounds

The First Credentials Experience Conference

The first Credentials Experience Conference will be held April 2-3, 2009 at the Chicago Marriott. The day and a half conference consists of 11 hours of intensive training, discussion and practical application on issues related to the toughest credentialing, privileging and competency problems.

Expert faculty include Hugh Greeley and Todd Sagin of HG Health Consultants, and Vicky Searcy of Morrisey Consulting

A Headline a Hospital Never Wants to See

Patient dies after surgery by doctor without credentials.  So reads a headline from ABC News in Queensland Australia. 

The article, complete with a photo of the hospital, goes on to to state that the Ethical Standards Unit, the Crime and Misconduct Commission and the Medical Board are investigating.

The investigation has revealed that Queensland Health has been provided misleading reports about credentialling. Rockhampton Hospital’s executive director of medical service was stood down (fired) in April 2008. 

Another reminder that the role of the medical staff services professional and the hospital Credentials Committee are vital to both patient safety and hospital reputation.

Cleveland Clinic Agrees to Supervise MinuteClinic Locations in NE Ohio

Cleveland Clinic announced today that it has formed a business relationship with CVS Pharmacy’s MinuteClinics in the greater Cleveland area. 

Clinic physicians will provide medical oversight of MinuteClinics at several CVS pharmacies in northeast Ohio. 

“The growth in this business is so enormous,” said Dr. David Bronson, chair of the Cleveland Clinic’s Medicine Institute. “We need to understand this and make sure this is integrated into a care system in some way that makes sense. We’re trying to give better care.”

Read more in Retail Healthcare News

This pattern follows the anticipated healthcare business model that I wrote about last year after attending the Estes Park Institute Healthcare Leadership conference.  “The delivery of healthcare is beginning to decentralize,”said several of the conference speakers.  “Care that now requires a trip to the doctor’s office, (sometimes considerable) time in the waiting room, and a wait of hours (or days) for test results, will increasingly be available remotely or in the local (think Walmart clinic) community. ”

“The primary (conference) take-away message?  Don’t expect tomorrow’s healthcare to look like today’s.”

Restraint and Seclusion – A Hot Topic for Hospitals

CMS and Joint Commission are taking the issue of patient restraint and seclusion seriously.  Hospitals and individual care givers must do the same,  Not just because of the regulatory agencies, but because patients deserve to feel safe, and to be treated with dignity. 

That having been said, some patients need to be restrained, for their own safety and for the safety of staff.  In my years working in an emergency department I saw more than a few abusive, dangerous, out-of-control patients.  Interestingly, I also noted that every one of those patients seemed to share the same basic four-letter-word vocabulary; there is a cultural phenomenon in there somewhere.

There are also patients who may need to be restrained to prevent them from unintentionally harming themselves by pulling out tubes, IV’s etc.

Hospitals are, however, seeking ways to reduce or eliminate the use of patient restraints, or to at least make their use safer when they are determined to be necessary.

On April 11, 2008 CMS issued updated Restraint and Seclusion Interpretive Guidelines for hospitals. Joint Commission standards have recently been updated to more closely align with CMS regulations.

Here are just a few points from the CMS Interpretive Guidelines.  A link to the full text can be found at the bottom of this post.  There are approximately 50 pages devoted to the topic of restraint and seclusion. 

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From the April, 2008 CMS Interpretive Guidelines for Hospitals:

All patients have the right to be free from physical or mental abuse, and corporal punishment.  All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff.

Hospital leadership is responsible for creating a culture that supports a patient’s right to be free from restraint or seclusion.

The use of restraints for the prevention of falls should not be considered a routine part of a falls prevention program.

Restraint use is separated in the guidelines into two primary categories:

  • Non-violent, non-self-destructive behavior
  • Violent, self-destructive behavior

CMS Surveyors are instructed to review medical record documentation to determine whether the number of patients who are placed in restraints increases on the weekends, on holidays, at night, or on certain shifts or units.  If patterns are noted, surveyors are to obtain nursing staffing schedules to determine if staffing levels are adequate or if particular nurses are more prone to use restraints.

In addition to the more obvious types of restraints, the guidelines also identify:

  • Medications used to manage behavior or restrict freedom of movement that are not standard to the patient’s treatment plan 
  • Physically holding a patient to administer medications against their wishes, unless the medication is court-ordered.
  • Four side-rails up in order to prevent a patient from getting out of bed

There are extensive ordering, monitoring, and documentation requirements, and surveyors will look for 100% compliance. 

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Becoming a patient is often a scary business.  Limited use of restraint and seclusion can help make the experience a bit less frightening.
 

4/11/2008 CMS Hospital Interpretive Guidelines, Restraint/Seclusion  (beginning on page #83)
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter08-18.pdf

Remote Area Medical Ohio Event Planned for May

A grassroots medical expedition is creating a groundswell here in Ohio. Local Cleveland hospitals and almost every agency involved in health care will collaborate to make sure anyone without health insurance gets medical care during a special event to be held in May.   

It’s called RAM Ohio. RAM is short for Remote Area Medical, an idea that has worked in rural Appalachia. It is modeled after RAM Tennessee

The event will take place May 2 and 3 at the Berea, Ohio Fairgrounds, and will bring together hundreds of volunteer doctors, dentists, optometrists and other healthcare providers and hundreds of general volunteers. Anybody that shows up qualifies for free healthcare. There is no pre-registration, so patients will have to be prepared for long waits. 

RAM is a totally grassroots effort run by volunteers, and there is no budget. Equipment is being donated, everything from x-ray machines to dental chairs and eyeglass frames.

Contact Information:

General non-medical volunteering: info@handsonneo.org
Medical volunteering: info@ramohio.org

Make a donation

Public Brochure

Mission Statement

News Coverage:

Cleveland Plain Dealer

WKYC News Report