Wednesday, August 26, 2009

The Health Care Debate

I read an interesting article this morning on the internet. The article is attributed to The headline read Health Care Debate Based on Total Lack of Logic, so of course I had to read it.

The crux of the article is that we are illogical (Mr. Spock has known that for 40 years). In the case of health care reform, each side starts with a conclusion, then works backward to find facts and data to support the conclusion. I know this to be true, because that's how I wrote an awful lot of my papers in graduate school. I'd write the paper, then go back to all the reference books to find supporting documentation to support my theory or hypothesis, instead of doing the research first. Today all you have to do is watch FOX or MSNBC to see this in action.

The article also made the point that the town hall meetings can promote even more rigid beliefs. Why? Because changing your mind about an idea can affect your sense of identity and sense of being part of a community.

So with that in mind, I think it might be helpful if we all take a step back, take a deep breath, and try to listen to the other side. Certainly each side of the debate has valid concerns and valid points that deserve to be heard.

Monday, August 24, 2009

Working With Older Adults

One of my soap boxes, as anyone who knows me will tell you, is that there aren't enough people specializing in aging issues, whether they are social workers, doctors, or even home builders. Over the years I've been to a lot of seminars lamenting this fact; I've even given a few of those seminars.

Go into any social work/nursing/medical school class and ask students what they plan to specialize in, and almost unanimously the answer is families/children/pediatrics/babies. I have yet speak to any class of college students where someone admits they want to work with older adults.

And I was the same way when I was in graduate school. I was going to work with teenagers, and my first job out of graduate school was with Child Protective Services. The strange thing is, I'm not a "kid" person, and never have been.

My colleagues and I have all tried to figure out how we can make working with older adults more appealing, going so far as to offer paid stipends to social work interns, with some limited success. The research that has been done on the subject has shown that students who have had positive experiences with older adults are more likely to consider working with older adults. So I was intrigued to read this article in the New York Times today.

It's about a program where medical students actually live in a nursing home for a short period of time. The students are given a "diagnosis" and they are expected to receive care just as if they actually had the diagnosis. The students interviewed for the piece talked about how they came away with a much better understanding of the needs and experiences of nursing home residents, but they also feel they interact differently with all patients.

This sounds like a unique program, and one that would benefit all kinds of health care professionals and students.

Monday, August 3, 2009

Health Care Reform

Much has been written lately about the proposed health care legislation, and I decided it was my turn to weigh in on the subject.

I will tell you up front that I have not read the entire 1000+ page bill. I have read one little part of it, and what I know from reading that part is that older adults will NOT be encouraged or forced to commit suicide. Neither will care be withheld from people at the end of their lives.

Let me explain what the bill does allow and encourage, and I'll use some examples.

In the last hospital where I worked, I worked in the intensive care unit. The patients there were really sick, and many died. There was one gentleman, who was only in his 60's, but with very serious end stage lung disease. He was on a ventilator, but he was alert and oriented. He knew he was not going to get better, and he knew the chances of coming off the ventilator were small. Sadly, no doctor was really forthcoming with this information; he just knew it to be true. When he did raise the issue with his doctors, they did at least confirm his suspicions. He then made the decision to stop the ventilator. I can't imaging how difficult a decision this was for him, but he had the courage to face the reality of his condition.

Conversely, there was another patient with the same diagnosis, although not as advanced. She was able to come off the ventilator, but she was actually told by her doctors that each time she went on the ventilator she risked not being able to come off of it. She refused to consider hospice, but she had no one to help care for her at home. She did not want to go to a nursing home. She was completely unrealistic about the course of her disease, despite having doctors who were very honest and realistic about her prognosis. She ended up going home, only to be re-hospitalized soon after and placed back on the ventilator. I heard that she died during that last hospitalization; I don't know if she ever came off the ventilator or not.

What do these two people have to do with health care reform? What the bill will do is require doctors to talk to their patients about advance directives. This is a good thing. The bill will also require doctors to talk to people with end stage diseases about hospice and palliative care; also a good thing.

Back in the early 1990s federal law began requiring hospitals to provide information to people about advance directives. Think about the last time you went to the hospital: a clerk probably gave you a brochure that told you about advance directives, and you probably threw it away. This is all the law requires currently.

Making serious end of life decisions is a conversation that we all need to have with our families and our doctors. When was the last time your doctor talked to you about what you want at the end of your life? I've never had a doctor talk to me about it.

Think back to the two patients I told you about. If their doctors had been having meaningful conversations with them about their disease process all along, perhaps if they had been encouraged by their doctors to talk to their families about end of life decisions, they might have both made different choices that would have allowed for more dignity and comfort at the very end of their lives.