Medical Bits – Vol. 1.2: Improving Communication
I was very glad to see a warm reception to our initial communication last month. Some of you replied with enthusiasm and a few posed some questions, which are pertinent and may be of interest to many of you. Therefore, I have decided to include a Q & A section at the bottom of our monthly endeavor. Accordingly, please feel free to respond with topics or questions you’d like me to address in future issues.
Injustice anywhere is a threat to justice everywhere.
How to Talk About Dying
Much has been written about this subject, yet, we forget or avoid it, and somehow, the issue may surface when patients and families face serious ailments or when the probability of survival declines. A recent survey showed that more than 90% of families concur this is an important subject to discuss and yet, only 30% of them had bridged the issue and often incompletely. Unfortunately, most of us will not die as those “lucky” characters portrayed in movies, but will rather slowly lose independence and executive function becoming feeble and sometimes unable to make decisions for ourselves to “fade into the horizon”. Despite all the talk about “patient-centered medical care” and “patient autonomy”, as our faculties decline it may become difficult to decide among complex options proposed by a medical team. It is important to discuss with our families and your physician what matters most to us. We realize that more treatment is not always best, and there is something called “burden of treatment”. A recent study found that over 17% of Medicare’s 550 billion-dollar budget is spent on patients’ last 6 months of life. So much of the care physicians provide in ERs and ICUs is futile; healthcare professionals frequently know who has a chance of meaningful survival and who does not from the outset of treatment. Yet, in our society where everyone is an expert and everyone has a valid opinion, those of professionals with expertise are frequently drowned out by “background noise” or simply ignored.
How to Approach “The Talk”
- Don’t wait until the end. It is best to take advantage of lucidity and strength. Acknowledge that it’s a difficult subject and then launch, “I am not sure how much time we have, but there are things I want to say and ask while I can…”
- Keep it brief and objective. It is easy to wander into welcome spiritual territory, but go back to your questions and try to keep focus.
- Respect heterogeneous beliefs.
- Not everyone is ready or willing to have this discussion.
- Do your best to be compassionate. Sometimes being present and silent is the most gracious attitude and may open up unexpected opportunities.
Some Valuable Resources
- https://theconversationproject.org/ (in collaboration with the Institute for Healthcare Improvement).
- https://www.dyingmatters.org/page/TalkingAboutDeathDying (Hospice UK)
- Multiple resources and videos: https://whenyoudie.org/resources/
As some of you may know, I have additional certification in Hospice and Palliative Care and would welcome your invitation to discuss some of these subjects and support you and your families to make decisions and answer some of these conundrums in this dynamic journey we call LIFE. Good communication with your physician may help keep you at the center of your care and ascertain that the “Medical Industrial Complex” respects your wishes and goals of care.
Changes to the Immunization Schedule 2019
Why do we need vaccinations and why do our needs change? Because our body’s defense change and our susceptibility to infections evolves over time. A process of immuno-senescence develops (your lymphocytes’ quality and ability to crank out immunoglobulins declines) and we need to re-challenge those lymphocytes and plasma cells to strengthen our defenses. Thus, all adults age 50 and older need the new shingles vaccine series, Shingrix. Additionally, Prevnar 13 and Pneumovax 23 are needed after the age of 65 to prevent serious pneumonia. Lastly, the tetanus, diphtheria, and pertussis (TDaP) vaccine booster is needed every 10 years. For more information, please click here.
Are Probiotics Money Down the Toilet? YES!
Interest in natural therapies has been rising, and the popularity of probiotics is no exception. Over the past 5 years, use of probiotics in the U.S. has quadrupled. Last year, US consumers spent an estimated $2.4 billion on the supplements. Several recent studies published in the Journal of the American Medical Association https://jamanetwork.com/journals/jama/fullarticle/2723633) question the benefits of probiotics. In my review, there is no convincing evidence of benefit from probiotics. Use the time sanctioned approach of a healthy and diverse diet, exercise, and don’t waste resources. They may end up in the toilet and down into our Chesapeake Bay!
Debunking Myths: Q & A
Hyperbaric oxygen therapy (HBO): Oxygen is an essential reactive gas with uniquely high concentrations in our atmosphere and the elixir of life. Multicellular, complex organisms would not be possible without the slow rise of O2 that ensued over the past 3.8 billion years, mostly as a result of algae, plants and phytoplankton which generated higher concentrations of O2 over millions of years. Live organs and tissues need adequate concentrations of oxygen, which does not mean that higher concentrations lead to magical results. The majority of O2 distributed to our tissues is bound to hemoglobin, a red cell protein highly specialized and easily saturated with O2 which is so efficient that it has been maintained through the evolution of species for millions of years. A very small amount of O2 arrives to the peripheral tissues dissolved in the plasma (the liquid component of our blood). This is the target of hyperbaric oxygen therapy whereby highly pressurized O2 can potentially increase the oxygen delivery to starved tissues.
HBO has been proven effective in treatment of decompression sickness (divers), carbon monoxide and cyanide intoxications and also accelerating wound care in patients with peripheral vascular disease. HBO can also cause neurologic and pulmonary complications if used in the wrong setting. Additional trials in burn victims, radiation injury patients, acute coronary syndromes, stroke victims and traumatic brain or spinal cord injury patients have failed to demonstrate benefit.
We will address other “myths” in future communications. In the meantime, keep cool, eat a nutritious and diverse diet, stay active and be happy! The only fountain of youth proven by science, experience and millennia are exercise, laughter, humor and a good positive attitude! We all know life is too short…
With offices in Los Angeles, California and Richmond, Virginia, SignatureMD (signaturemd.com) is one of the nation’s largest firms providing initial conversion and ongoing support services to concierge medicine physicians. SignatureMD currently partners with more than 160 affiliated primary care physicians and specialists across 31 states, and its network is rapidly expanding.