Navigating Healthcare – Patient Safety and Personal Healthcare Management

Happy Birthday to my Best Friend

Posted in Inspiration, Kenya, life by drnic on April 19, 2017

 

I married my best friend and today is her birthday. This post: If You Want To Be Successful, Marry Your Best Friend detailed exactly why.

In this world of individualized culture that focuses on independence and self-reliance I am happy to say I am not. We are one and success and failure is our success and failure. We are programmed to have relationships and to belong — for those of you skeptical or feeling like you need independence you might just be suffering from the “dependency paradox”. I give up nothing and gain everything.

people who are more dependent on their partners for support actually experience more independence and autonomy, not less

This is what I would term “Healthy Dependency” and something that contrary to some viewpoints that see this as a negative quality in a relationship it is not but rather makes me a better person, stronger and more independent, successful and happier. I depend on her — we share the ups and downs of life and travel this journey called life together

Happiness is an experience best shared and I am lucky to be sharing this with my best friend and wife

Palazzo Vecchio with Uffizi in the Background

“The need for someone to share our lives with is part of our genetic makeup and has nothing to do with how much we love ourselves or how fulfilled we feel on our own. Once we choose someone special, powerful and often uncontrollable forces come into play. New patterns of behavior kick in regardless of how independent we are and despite our conscious wills.”

I love traveling this road with you and wish you a very Happy Birthday — We are One

Or the African version from this African boy

Happy Birthday to my Best Friend was originally published on Dr Nick – The Incrementalist

Advertisements

How Americans Die

How Americans Die This is a fantastic visual presentation of data that you can look at in more detail on the Bloomberg Site If the embedded page does not work head over there directly here

The main points highlighted

  • The mortality rate fell by about 17 percent from 1968 through 2010, years for which we have detailed data…Almost all of this improvement can be attributed to improved survival prospects for males
  • The surge in for 25- to 44-year-olds was caused by AIDS, which at its peak, killed more than 40,000 Americans a year (more than 30,000 of whom were 25 to 44 years old)
  • AIDS was the single biggest killer of Americans who should otherwise have been in the prime of their lives (Sobering Statistic)
  • 45- to 54-year-olds are less likely to die from disease, they have become much more likely to commit suicide or die from drugs
  • How does suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise. (Suicide and has recently become the number one violent cause of death) – (Sad Statistic)
  • The downside of living longer is that it dramatically increases the odds of getting dementia or Alzheimer’s
  • The rise of Alzheimer’s and other forms of dementia has had a big impact on health-care costs because these diseases kill their victims slowly. About 40 percent of the total increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment

They do a great job of slicing the data by cohorts of age groups showing how much we have improved mortality and how our 25 and under age group is benefiting from the health improvements with the lower mortality and higher life expectancy than any other cohrot

Thanksgiving, Decency and End of Life – Be Thankful you had the conversation now #health

Patients deserve the same standard and car that doctors receive when they need treatment. But as I have said before (Doctors Die Differently and more recently Treatment Creep in Medicine – sucking Decency out of Patients) we remain challenged especially when it comes to dying.

This piece by Dan Gorenstein, How Doctors Die: Showing Others the Way touched on these issues in a moving a thoughtful way.

Dr. Elizabeth D. McKinley’s battled breast cancer for 17 years but this past spring discovered the cancer had spread to her liver, lungs and brain. Her choice was to undergo more treatment that would have potentially debilitating and mind altering effects on her or change course, accept death and work on getting the best out of what was left of her life…as she put it

..time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean…“a little more time being me and not being somebody else.” 

And some of her fight was with her own family – the non-medical members

clinging to the promise of medicine as limitless

And the medical members of her family (her husband is a radiologist)

looking at her disease as doctors, who know the limits of medicine

Its not a difference in the effects of disease and death but rather an advantage of knowledge and information that lead to truly informed decisions “doctors have control over their quality of life before they die and this sadly is control that eludes most other members of society” and it would appear especially try here in the USA. More than half of deaths take place in hospital and not at home surrounded by people we love which is the way most say they want to “go”.

So if you do nothing else this Thanksgiving – take the time to talk about the subject with the people you love and create and advance directive or living will. In many respects no better way to be thankful than to set out what is important and let everyone know, now when you are fit and healthy.

Wishing you all a very happy family and friend fill Thanksgiving

Doctors Die Differently

It was this podcast, “The Bitter End

From the awesome radio show radiolab that covered a topic that people are often reluctant to discuss but is an important part of our reality…as they say there are few things in life but birth death (and taxes) are at the top of the list.

The piece included a review from the Johns Hopkins (Study of a LifeTime) of people’s desires when it comes to life saving treatments especially as it relates to end of life:

Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given. Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, “Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?”

For some simple questions such as:

  • Would you want CPR administered
  • Would you want Artifical Ventilation administered
  • Would you want Dialysis administered
  • Would you want a Feeding Tube used

Physicians were fairly uniform with 80% declining all of the above therapies. The only question that physicians were uniformly in favor of was the administration of pain medication.

But ask the same question of the general public and the numbers are reversed on every therapy (except pain management where there is agreement)

Its not that doctors don’t want to die, its just that they knwo they know enough about modern medicine to know its limits, importantly they have talked about this with their families as they want to be sure that no heroic measures will be used during their last moments in this reality.

In this excellent piece: “How Doctors Die; It’s Not Like the Rest of Us, But It Should Be” Ken Murray elegantly discusses this discrepancy

The challenge is clear and effective communication on a topic that we are reluctant to take on:

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

My personal technique when I was practicing was to use the benchmark of my own family. Depending on the age fo the patient I would ask myself the questions:

What would I do if this was my <insert name of close family relative>

So:

What would I do if this was my son/daughter
What would I do if this was my spouse
What would I do if this was my mother/father/brother/sister
What would I do if this was my grandfather/grandmother

It may seem simple but it worked for me, and still does. The principle applies with general discussions between family members and realtives.

I knwo this seems morose and depressing but remember death is not alwasy the worst case scenario.