"Health" Magazine Writer, Suz Redfearn, Advocates Deceptive Practices

The teaser arrived in my email box---Nine Secrets Health Insurers Don’t Want You to Know---and I clicked. Suz Redfearn, a freelance writer, says that

To get tested, talk up your symptoms.Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed.

First, this is obviously not a colonoscopy but a flexible sigmoidoscopy. It costs a lot more for the more extensive procedure that checks the right side of the large bowel in addition to the transvers and descending colon. And sedation typically is not given for the flexible sigmoidoscopy. Most patients do not require colorectal cancer screenings before the age of 50. These exceptions include those with a history of familial adenomatous polyposis, obvious changes in bowel habits (bleeding, changes in diameter of stools, and unexplained anemia), and first-degree relatives diagnosed with colorectal cancer.

The National Cancer Institute has a wonderful site that explains the various options available for colorectal cancer screening. I would encourage all patients to discuss their risks with their providers and not resort to subterfuge or lying in order to obtain a test that may not be necessary.

I sent a letter to Health stating my disappointment with their decision to publish an article that advocates lying and deception in the patient-provider relationship. Healthcare providers already manage patients who claim they take all their medications as prescribed, who exercise as recommended, and who avoid dangerous health practices. Let's add another nail of skepticism to the communication coffin.

Other blogs about this article include:
California Medicine Man
Kevin MD Medical Blog

October is National Breast Cancer Awareness Month

In the summer of 1994, our neighbor wore a turban and we learned she had breast cancer. I remember being invited over to their apartment with walls lined with books from floor to ceiling. She and her husband had three children who were crammed into this little apartment.

One day we came home to find her crying in the hallway. "Are you okay?" we asked, concerned. She shook her head no. "It's in my bones," she said.

I've thought about her off and on over the years. The five-year survival rate for breast cancer with metastasis to the bones is 21%. I hope she is still alive; her husband and children deserve that much.

Breast cancer is the leading cause of death in women ages 20-59 while lung cancer is the leading cause of death in women ages 60 and older. Breast cancer diagnosed in the early stage, that is, while it is still localized to the breast has a 96% chance of survival. This is why mammography is so important. There are no early signs or symptoms of breast cancer; even the monthly breast self-exam (BSE) detects cancers at much later stages than radiology.

My annual mammogram is scheduled for this month and I am not looking forward to it. However, the inconvenience and pain of being diagnosed with breast cancer far outweighs the inconvenience and pain of this diagnostic exam.

For more information, please check http://www.nationalbreastcancer.org/

Too Sick to Take Meds

From the Chicago Tribune:

"In a new study published Thursday, a group of University of Chicago doctors found many diabetics believe that the inconvenience and discomfort of their treatments, especially multiple daily insulin injections, were as bad as the complications that can result from not treating their disease.

"Some patients, 10 percent to 18 percent of the total, said their treatments were so arduous that they would be willing to die sooner -- some said up to 10 years earlier -- if they could stop their medications.

""Some of this might be lack of education and people not understanding the disease process," said Dr. Holly Mattix-Kramer, a specialist in preventive medicine and kidney disease at Loyola University Chicago Stritch School of Medicine. "We need to do a better job educating our patients about what preventive care means and how it may affect their life span.""

I wonder if the providers evaluated these patients for depression.

There is a lot of support given to patients who are diagnosed with cancer. We have cancer support groups, we hold fund-raisers, and we generally don't fault these people for getting cancer (well, maybe we think smokers have it coming....).

In any case, there is no support for diabetics. Many diabetics have made lifestyle choices that have predisposed them to diabetes and, for some, lifestyle choices may have delayed but did not prevent the onset of diabetes. So others look at these people and "should" all over them. "You should have watched your diet. You should have lost weight. You should have..."

You cannot be dumb when you have a chronic illness. You have to track all sorts of medications, the timing, the changes in your diet and lifestyle (to include exercise and stress management as well as checking your feet every night) and then tweak your dosages when the next evidence-based practices are published. This means multiple visits to your provider and pharmacy and maybe visits to the emergency department when you take too much or too little of a medication. Think about all the time spent on managing this illness...

A multitude of factors comes into play here---psychological costs as well as very real physical costs. My only hope, as an adult nurse practitioner and clinical nurse specialist in adult health, is that these patients make INFORMED decisions---that is, they understand the full ramifications of the radical steps they are about to make and understand they may not be able to change their minds once they start down that path.

If they are honestly able to make this decision (and not just overwhelmed with the sheer agony of it all), then we as fellow humans have an obligation to support them in their decision and to allow them to die with dignity and grace.

New Assignment

I've been in the General Surgery Clinic for a month now (no more Dead End Corridor!). Life here is certainly different from life on the Multi-Service Unit. For one thing, I don't supervise any nurses and I have a capable and confident HM3 who manages the clinic itself and trains new corpsmen.

My main role here is to assist with endoscopic procedures through administration of intravenous conscious sedation (IVCS). I thought this would get boring, but I've been pretty interested in all the cases we've done so far (57 cases, if you include the 6 in which I was supervised to re-certify for IVCS and the 6 I supervised another nurse to get her IVCS-certified).

Today we saw worms.

Dr C got the willies. "I can't wash my hands enough after this," he declared. He kept muttering, "Wait till my friends see this on You-Tube." Then he'd shiver some more.

Medical Mistakes Happen

This newspaper in Wisconsin details some of the medical mistakes healthcare providers make. Here is another link to a web site for journalists covering healthcare: http://www.healthjournalism.org/

I regularly receive the ISMP newsletter (offers free CEUs twice a year!) and have been amazed at some of the errors RNs have made. As nurses, we are instructed to use the "6 rights" of medication administration:

1. Right patient



2. Right medication



3. Right dose



4. Right route



5. Right time



6. Right indication

However, using these 6 rights does not guarantee patient safety. Critical thinking skills are essential and even then they can fail the best nurse, especially in Hour 10 or 11 of a 12-hour shift on the third day of a string of 12-hour shifts.

Patients must take responsibility and ask questions about the medications that are being administered to them. I frequently encounter patients who have no idea what medications they are taking or what they're used for.

Here is a link to an online medication form that patients can use to fill out and carry with them at all times. The Institute for Healthcare Improvement (IHI) provides extensive information from hospitals nationwide who have implemented safer healthcare delivery practices. The site requires free registration to access information and I have found it to be a wonderful resource.

As an RN, I tell my patients they should always ask who the person is who is administering the medication (are they an RN? a CNA? a crazed patient from room 210 who is offering you his stashed medicines?). Patients should also ask what the medication is, the dosage, and what the medication is used for. The RN should also instruct the patient on the common side effects and what the patient should do if he or she experiences one of them. However, this would happen consistently in the ideal world and that's not where we live.

Dinosaur Nursing

We were critically short-staffed before and now one of our nurses left on emergency leave this morning. You can't run a schedule with five nurses. In the meantime, I've been moved out of the MSU to General Surgery. They chose another nurse to cover both her clinic and the MSU which doesn't make sense. I still had to manage a physical readiness issue for one of the sailors and I am writing three end-of-tour awards for staff detaching in the next couple of months. I also have to turn over with the Division Officer who will be taking my place.

The other nurse covering the ward chose to have nurses work 8-hour shifts in addition to their regularly scheduled 12-hour shifts so a new graduate nurse was not left on his own on the night shift. I argued that the 8-hour shifts would actually be longer because things happen and staff would be reluctant to leave, even when their shift was over. She responded, "When I was a nurse at their level of experience, I had to work seven shifts to get four off!"

I replied, "Dinosaur nursing doesn't work nowadays."

She retorted, "These nurses are just BABIES! They need to suck it up."

Quietly, I said, "These nurses are not babies. They are adults who have different priorities." But she had already turned and walked away.

It's times like this that I have to apply the 5-year rule: Will this really matter in 5 years? And my response is no. And I am sick and tired of the phrase, "Suck it up."

Slow Leadership says this:

"...organizations rely on people's feelings of loyalty. Not loyalty to the business, mostly, but loyalty to colleagues, who will be forced to take up any slack if someone refuses to give up vacation time or work a 60 or 70-hour week." The best workers vote with their feet: "Those with the most courage, the highest levels of self-confidence, the greatest commitment to ethical principles, and the strongest personal values leave."

Slow Leadership continues: "One of the differences between high levels of stress and actual burnout is the presence of depression. Someone suffering burnout has given up. He or she no longer has the power to fight, nor the self-esteem to put the blame on the organization, where it belongs. The burnout victim was, typically, an ambitious high-flier, a good team player who gave and gave until
there was nothing left to give."

Finally, Slow Leadership says, "Work is part of life, not the other way around."

What I should have asked this senior nurse is, "Don't you remember how angry, how powerless you felt when you were given these demands? Didn't you vow then to never become that kind of nurse or leader?"

Managing Across the Generations

One of the blogs I frequently read is Penelope Trunk. She posted a report published by Deloitte & Touche on managing across the generations. You can download the report here:
http://blog.penelopetrunk.com/wp-content/uploads/2007/07/deloitte-generations.pdf

I also recently read a report in Training Magazine that despite beliefs generational differences exist, all generations share core values which include an emphasis on family.

My husband has told me I can "stay Navy" or I can stay married. The biggest change in regarding the Navy as employer of choice is the massive number of hours I work at the expense of time with my family. At this point, I am working over 50 hours a week. There have been times in the past few months where I have worked six 12-hour shifts in the space of seven days. Unfortunately, I am not the only one in this situation. This will have increasingly chilling aspects for Navy recruiting as it attempts to do more with less.