Our 85-year-old neighbor, Dorothy, was taking 14 medications a day. She could barely get out of bed because of fatigue and mental confusion. With her adult children living out of state, my husband and I look out of her. Even with 24/7 caregivers, additional oversight is important.

When I spoke with her son, I strongly encouraged a medication review with Dorothy’s primary care physician (internist.) He soon visited and took his mom to her doctor, complete with a list of all her medications and dosages, over-the-counter medications, herbs and supplements. Her physician cut her prescription medications in half and changed a couple of others. Weeks later, Dorothy is nearly her old self again and is back to walking with her caregiver down our street.

Over-medication in the elderly is a serious and very common problem. According to The Journal of Family Practice, nearly 9 out of 10 U.S. residents who are over the age of 60 take at least one prescription medication. More than a third take 5-9 medications, and 12 percent take 10 or more. The risk of adverse drug effects and dangerous drug interactions increases significantly when a person takes more than 5 medications.

Such was the case with Dorothy. Several of her medications were causing side effects and those side effects were then treated with more medications. Multiple specialists were involved in her case and none communicated with one another. Each prescribed more medications to treat her symptoms. This is a phenomenon known as “the prescribing cascade.” Her caregivers did as instructed by helping her take her 14 medications a day and her adult children weren’t aware that “polypharmacy”  can be downright dangerous for the elderly.

Why is “polypharmacy” such a problem in the elderly? Aging affects how the body handles medications, meaning the elderly metabolize and eliminate medications less efficiently. 

If you’re caring for an elderly patient who is taking multiple medications you need to know that they can be at high risk for drug related problems.

Following are 9 strategies to help:

1. If your elderly patient is taking multiple medications and sees more than one medical provider (doctor, nurse, PA, NP), create a list of all prescribed medications and their dosages. Include over-the-counter medications, herbs and supplements. In addition, add allergies to medications. Bring this list to each visit with the patient’s medical providers.

2. Ask the patient’s primary care physician to review the list of medications. Ask questions. 

3. Talk to the patient’s pharmacist and ask for a medication review. A pharmacist’s training, education and expertise is in medications. They are there to help you. Ask questions.

4. Use one pharmacy to fill all of the patient’s prescriptions. Drug interactions, duplicate medications and allergies to medications will be caught.

5. Different medical providers might unknowingly prescribe duplicate medications for the patient if the patient does not present a list. This confusion can also occur with brand and generic medications. For example, the patient takes the generic, which has a different name than the brand. Both are the same medication. Medication samples are always brand.

6. Keep a symptom diary in partnership with the patient. If you notice new symptoms, keep a log of what the patient experiences on a daily basis. Ask the patient to contribute or if he/she is unable, document your own observations. Ask the following questions:

-When did the symptoms begin?

-Was a new medication started when symptoms began?

-How long do the symptoms last?

7.  Modern Medicine states that if the patient starts experiencing GI distress, it can be because of a new medication. Be on the look out for nausea, vomiting, diarrhea, constipation and stomach pain.

8. If there is a change in the patient’s mental status such as drowsiness, impaired memory, confusion, prolonged sedation, it might be because of medication. Some antidepressants, muscle relaxants, antispasmodics and antihistamines can also cause confusion, blurred vision, dry mouth, dizziness and difficulty with urination. Ask the patient’s primary care physician questions. Speak up. 

9. If any of these or other symptoms occur, bring it to the doctor’s attention and show him/her the patient’s symptom diary.

10. If you are an advocate or caregiver for an elderly patient, it is very important to be informed about the patient’s medications. Older patients may see several different specialists who don’t communicate with one another and have no idea which medications the patient is taking. 

Good resource: Beers Criteria (medication list) of potentially inappropriate medications for the elderly https://www.dcri.org/trial-participation/the-beers-list

 

For more information, please visit www.thetakechargepatient.com

 

 

 

 

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Tips for a Successful Doctor Visit

By Camille Peri
WebMD Feature
Before a doctor appointment, you probably think of the things you want to talk about. 

In the shower, you remember that you should ask about those itchy bumps on your scalp. Or grocery shopping reminds you of a question about blood pressure. But then you’re there, sitting on the exam table with minutes of your doctor’s time, and you draw a blank.

“It’s difficult to recall symptoms or questions at a doctor visit because you’re nervous,” and that anxiety can mess with your memory, says Martine Ehrenclou, author of The Take-Charge Patient: How You Can Get The Best Medical Care.

You’re not alone if you squander your chance to pipe up. The average person asks five or less questions per doctor visit, says Sherrie H. Kaplan, MPH, PhD, co-director of the Health Policy Research Institute at the University of California School of Medicine in Irvine. And men are more close-lipped than women. They average zero questions per visit, she says. If it’s any consolation, “doctors are no better at it when they are patients.”

The more you participate in your doctor visits, though, the more you’ll get out of them.

“A good doctor-patient relationship isn’t just nice to have,” Kaplan says. “We’ve learned from studies that patients who participate more in treatment decisions have better health outcomes.”

These tips can help you speak up and have better visits.

Before-Visit Prep Tips

Unless you enjoy pop quizzes, prepare for your doctor visit in advance. Plan to bring with you:

  • Copies of medical records, if this is your first visit
  • Medications, vitamins, and supplements you’re taking, or a list of them
  • Information about recent medical tests
  • The names and contact information of other doctors you see
  • A list of your questions
  • A symptom diary

The more detailed you can make your symptom diary, the better. For instance, if you have stomachaches, Ehrenclou says, keep track of “when they began, when you notice them most, what makes them better or worse, if they coincided with an illness or new medication, and what you think may be causing them. Try to track them on a daily basis, or as best you can.”

Try these tips just before your visit:

  • Pick your top questions. You have a list of things you want to cover. Your doctor does, too. Chances are, you may not be able to cover all your questions in one visit. So pick the three or four concerns that are most important to you.
  • Rehearse at home. If it helps, practice giving your medical history out loud. Expect typical questions, like: What was the date of your last menstrual period? “Women always get that question from their ob/gyn doctor, and they’re almost never prepared with the answer,” Kaplan says.

Preparing not only saves precious time with your doctor — it also sets the tone for the visit. “Your doctor knows you’re taking health care seriously,” Ehrenclou says.

Top Doctor-Visit Tips

Here’s how to get what you want out of an appointment:

  • Get comfortable. If you’re tense on the exam table, tell the doctor or nurse what would help you relax. If you’d like a nurse, friend, or family member there, let the doctor know.
  • Be honest. Topics like sex or illegal drug use may be tough to discuss, but your doctor needs to know about them to give you the right care. Keep in mind, your doctor cannot discuss anything you tell him without your permission. Having a friend or family member there may make it easier.
  • Take time. The better you’re able to explain your concerns, the better your doctor can advise you about them. Stay focused, but don’t rush through a symptom if giving more information could be more helpful for your doctor.
  • Ask follow-up questions. If you don’t understand your diagnosis or treatment, speak up. If you don’t feel that you can follow through with a treatment, find out if there are other options. If you need someone who speaks your preferred language, let your doctor know.
  • Take notes. Or bring along a friend or family member to take notes or ask questions.
  • Find out how to keep in touch. Can you email your doctor? Or is it better to leave a phone message? Before you leave, ask for the best way to reach him if you have questions about what you’ve discussed.

Link to WebMD Interview of Martine Ehrenclou http://www.webmd.com/a-to-z-guides/features/visit-tips?printing=true

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The doctor-patient relationship with dying patients

Perhaps we thought we could get away with ignoring the relationship between doctors and patients. The Kaiser Health News article, “Efforts to Instill Empathy Among Doctors is Paying Dividends,” explains why we can’t.

Patient satisfaction scores and reimbursements aside, this relationship was once considered the cornerstone of quality care.

Doctors are healers but in recent years many have been reduced to diagnosticians, electronic medical records (EMR) data entry clerks, and health insurance appeal wranglers. They are so much more than that, but with 7 to 15 minutes per patient, it’s a challenge to fit in what used to be an intimate relationship with patients.

The changing face of health care has whittled down doctors’ relationships with patients to close encounters-of-the-impersonal kind. Physicians are fleeing their practices, selling them to hospitals, moving into concierge medicine, and more. Many are frustrated with how healthcare has changed the way they practice medicine. Some have found ways to salvage it.

A physician friend recently revealed to me that she doesn’t leave her office until 7:30 or 8 p.m. each night because of the EMR data entry program dictated by the hospital corporation that purchased her practice. She now has massive computer screens in each exam room. In her office, a towering computer screen looms over her desk. Seated in her once-comfortable office, I was startled by its presence.

With a sigh, she said, “It takes so much time to input patient information into the computerized forms. I can’t just type it out. I’m pigeonholed into forms and boxes that don’t allow me to just type in notes.”

With a dying patient, I wonder how much time doctors have to spend listening, waiting for patients to ask the questions instead of harnessing the conversations with their own. Atul Gawande so poignantly pointed out in his PBS/Frontline interview, Hope is Not a Plan, that conversations about end of life must include sitting with patients to allow them the space to reveal what is most important to them in their final days.

Dying is a lonely business for patients, which is why Jeremy Force, the first-year oncology student from the Kaiser Health News article, was so important to the dying cancer patient. He allowed for meaningful impact with that patient just by being present, by validating her experience, listening intently, and offering empathy. If that wasn’t life changing for him as well as the patient, I don’t know what is.

Jeremy Force used strategies he’d learned in a day-long course by Oncotalk, which is required of Duke University’s oncology fellows, as well as by University of Pittsburgh and several other medical schools. Dr. Force acknowledged what his patient was going through, provided empathy and employed active listening skills. In essence, he paved the way for the all important doctor-patient relationship.

A few days later, Jeremy Force ran into his patient in the hall of the hospital. She conveyed her appreciation and gratitude for his approach. The key, of course, is Force as a human being, ultimately revealed by his response. He said, “It was an honor.”

Maybe all doctors and patients can learn from this, push for the relationship between doctors and patients to be valued over data entry and reimbursements. We have to try.

Martine Ehrenclou is a patient advocate.  She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.

TAGGED AS: PALLIATIVE CAREPATIENTS

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Whether you are dealing with a new medical problem, an ongoing condition, or a serious illness, having a roadmap to guide you through the healthcare maze is invaluable.

The Patient’s Toolkit was developed to help you actively participate in care and engage with your doctors and nurses with more confidence.  You can download the toolkit here.  It is free.

The Patient’s Toolkit includes several forms, checklists and sample questions to guide you through key points in your medical care. It is a companion piece to my award-winning book, The Take-Charge Patient.

Your medical care is a team effort and you are a very important part of the process. To increase the quality and safety of your care, these easy-to-use and simple aids allow you to maximize the time with your medical providers and assist you to become more informed.

Many patients and their advocate families do not know how to navigate our complex healthcare system, how to ask questions or which questions to ask, how to track symptoms to support a physician’s efforts to arrive at an accurate diagnosis, make the most of precious minutes with a doctor, and prevent medical errors.

The Patient’s Toolkit is your personal guide. It includes a medical ID card that you can fill out and slip into your wallet so you have it with you at all times so you don’t have to depend on your smart phone or other electronic device. You can download the Patient’s Toolkit here.

If you are actively involved in your care and become informed about your diagnosis and treatment plan, you will experience increased safety and better quality care, according to the Health Affairs article, Patient Engagement

Ask questions if you do not understand something your doctor or nurse explains to you. Medical information can be complex and it’s foreign to most. Use The Patient’s Toolkit to document information about your diagnosis, treatment, next steps and when to follow up with your medical provider. Being prepared will increase your self-confidence and maximize the time you have with your medical provider.

I look forward to hearing from you about your success with your new Patient’s Toolkit. Your suggestions are welcomed.

For for information on The Take-Charge Patient: How You Can Get the Best Medical Care, please visit www.thetakechargepatient.com

 

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A new study from South Korea suggests that most patients and families are willing to remind hospital healthcare workers to wash their hands to prevent the spread of infection. With 1.7 million healthcare associated infections occurring every year and 99,000 deaths as a result, it could be a live-saving request.

Proper hand washing is the most effective way to prevent the spread of infections in hospitals, according to MedlinePlus.

The catch, according to the new study at the Seoul National University College of Medicine, is that many doctors and nurses don’t welcome a prompt to wash their hands. Only 26 percent of doctors and 31 percent of nurses supported the idea of patients’ requests to wash their hands. The most common reason for their resistance was concern about negative affects on the relationships with patients.

You’d think that doctors and nurses would be more concerned about spreading healthcare-associated infections that sicken their patients than damaging the provider-patient relationship.

With studies showing that healthcare workers wash their hands about 30 percent of the time, you bet I’d be willing to make the request. I’ve done it before and I would do it again. Is it uncomfortable? Yes. Is it worth it? You tell me.

I’d taken my daughter to the pediatrician for an ear infection, one of many that year. We waited in an exam room with the door open to view the front desk and another exam room. I watched as the pediatrician, who was subbing for my daughter’s regular doctor, touched two four-year-old twin boys in the exam room across from us. The boys were coughing like crazy. When she was finished, this doctor walked directly from that exam room and into ours. She headed for my daughter without stopping at the sink to wash her hands.

As she reached for my daughter, I stopped her and said, “Lucy’s been sick a lot this winter. Would you please wash your hands before touching her?”

Our eyes locked. There was a moment of subtext between us before she turned toward the sink and washed her hands. Was it worth the discomfort to prevent my daughter from possibly being infected with the illness from the two twin boys? Yes.

If you’re ever hesitant to make the same request for yourself, imagine you are doing it for your child or an older, vulnerable loved one. Keep in mind that it’s important to be polite when making the request. The doctor or nurse might have just have just forgotten while in a rush to get to the next patient.

Sample Questions to Use with Healthcare Providers

1. My loved one is susceptible to infection. I’m concerned about her health. Would you please wash your hands before touching her?

2. I’m concerned about the 1.7 million healthcare associated infections every year. I’m just trying to do my part to reduce them and keep myself safe. Would you mind washing your hands before touching me?

3. You’ve probably washed your hands already but I just can’t risk getting sick again. Would you please wash your hands? I respect you as a doctor (or nurse) but I just need to be careful.

It might sound like these questions are too carefully worded. It’s a given that patients deserve to be touched with clean hands and not subjected to possible infections. However, the bottom line is that most healthcare providers do not wash their hands nearly enough. Let’s just deal with the facts and go straight to increasing patient safety. And while you’re at it, wash your hands too. 

Regardless of any discomfort, ask your healthcare providers to wash their hands! It could save a life. 

For more information on patient safety, please visit www.thetakechargepatient.com

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