October 6, 2016
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Being responsible for a seriously ill family member is challenging for anyone, even if that family member is a physician. In this week’s issue of TIME, two physicians describe navigating the treacherous seas of end of life care. Robert Kane, MD, a professor of Long-Term Care and Aging at the University of Minnesota, writes that after a stroke, his mother was given sedation medication, which caused delirium. After Kane alerted staff to the delirium and a notation was made in her chart, the drug was given again. Later when his mother transferred to assisted living and then nursing home care, Kane offered solutions for her continuing medical problems and was told there was no deviating from facility procedures. He offered to sign waivers of liability to circumvent the regulations, but the facility stood firm. Co-author of the Time article, Jennifer Brokaw, MD, an emergency physician and founder of C2it, tells a similar story of caring for an uncle suffering from dementia. Clinicians medicated him for behavioral issues, which made him more compliant, but caused sleepiness and left him unsteady on his feet. Brokaw insisted all drugs be discontinued. As his disease progressed, he became combative, and the facility threatened to transfer him to a “place with more safety measures.” That meant physical and more sedation. “If the most skilled people in the country have serious problems getting high-quality, long-term care for their loved ones,” the authors asked, “what chance do lay people have? We need to invest in making [care] better.”
This October, organizations across America are holding events and fundraisers in recognition of Breast Cancer Awareness Month. One of the organizations, the National Football League holds a “Go Pink” campaign, but contributes nothing to cancer research, despite its $12 billion a year annual revenue–more than double the annual budget of the National Cancer Institute. In a Wall Street Journal opinion piece this week, cancer surgeon Marty Makary, MD, MPH argues that “Go Pink” is nothing more than shrewd marketing by the NFL to attract more women viewers (many of whom may be previously disillusioned by the organization’s lackluster response to domestic violence allegations). To make real progress towards curing breast cancer, we need to fund research for effective treatments, instead of rewarding companies for paying lip service to the cause.
In the frantic, noisy, and chaotic environment of an emergency department, stopping occasionally to listen and take in the moment can make the difference between clinicians providing the right care and a medical error. For Right Care Action Week, Jane Muir, BSN, RN, an emergency medicine nurse at the University of Virginia, is organizing several events to demonstrate the importance of mindful listening and to learn different perspectives on right care. One event she is planning is the second annual “Social Histories” Story Slam at UVA, during which a diverse panel of clinicians share how they avoided harming a patient unnecessarily by taking a purposeful pause. Last year, one nurse told her story about a particularly busy day in the OR, when her team would have performed surgery on the patient’s wrong knee had she not requested and taken a “time out” to review the surgical plan. The title of the story slam, “Social Histories,” is meant to bring clinicians’ attention to the whole patient, not just their medical history. “It’s not just about the patient’s experience once they walk into the hospital,” said Muir. “It’s about what was happening on the bus before they got to the hospital, it’s about not having a way to get home.” Read the blog about Muir here. And don’t forget to sign up for RCAW!
To address overprescribing of opioids, the DC Center for Rational Prescribing is offering two continuing education courses that skewer industry-driven myths, and help physicians, pharmacists, and nurses counsel patients about getting off of opioids. Accredited courses are available at no cost to DC physicians, physician assistants, nurses and pharmacists. More information here.
A gentle reminder: We are calling for abstracts and proposals for skill-building workshops for the 5th annual Lown Institute Conference on May 5-7, 2017. For more on submitting an abstract for our research symposium, go here. For more on submitting a proposal for our skill-building workshops on Saturday, May 6, go here. The deadline for both submissions is December 18, 2016.
Conflicts of interest
End of life
Health care models
RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.