Healthcare

Building Bridges, Creating Bonds

Dear Readers,

I’m glad to start the category and section on the blog: NURSING AND INTEGRATIVE MEDICINE. At the same time, we have launched on social media the campaign:

#Enfermeríaymedicinaintegrativa

(Integrative nursing and medicine)

WHY?

Because now is time to build bridges and create bonds.

WHAT FOR?

– Giving visibility and presence to holistic professional care.

– Opening a common space in which nurses and doctors work together with an integrated approach based on what bring us together: people’s welfare.

– Understanding that different approaches and perspectives of health are enrichment opportunities for all.

– Sharing research, scientific articles, evidence.

– Generate knowledge.

– Creating a rigorous and serious file where health professionals and people (patients) may be able to find reference material and support.

– Creating critical consciousness in health.

WHO FOR?

Absolutely for everyone, health professionals, patients, families, and anyone who would be interested.

I would like to say thank you in advance for your support and diffusion. I trust you!

Love,

Elena Lorente Guerrero

*Re-posted with permission and original can be found at: https://coloringnursing.wordpress.com/2015/07/14/enfermeriaymedicinaintegrativa-building-bridges-creating-bonds/

Healthcare

The Intimacy Gap

I used to think that there was a communication gulf between doctors and patients. Somewhere in the hub-bub of of the harried office visit some secret sauce was missing. A divide that was so fundamental that both parties often left the room feeling disjointed and uneasy. Patients wondered if doctors truly heard them. Physicians wondered if any one was listening to what they were saying. The tension ebbed and flowed, but never disappeared. This has been the state of health care over the last decade. This has been the environment in which I have built my clinical career.

I now believe that the term “communication” is imperfect and lacks the specificity that I am looking for. I think what we truly have is an intimacy gap. What separates doctors and patients is a disjointed and unnatural version of intimacy that in no way mirrors the important bonds that we form in real life non-medical relationships.

Let me explain.

A patient walks into the exam room and unloads the most intimate, embarrassing, and frightening secrets to their doctor. Unlike close friends or loved ones, the physician has in no way earned this privilege. They had not gained this right through hours of conversation, years of support, or acts of selflessness. There is no shared struggle or trust. It is given too freely.

The doctor listens patiently and kindheartedly. But the interaction can only be so rewarding. There is no mutual disclosure of secrets. No bidirectional sharing of intimacy. The physician remains stone faced, objectively detached. This is what we learned in training.

The practitioner, conversely, is bombarded day in and day out with urgent and emergent situations. There often is no normal period to engage and form stronger bonds. They are shuttled from exam room to exam room trying to put out fires without any of the nicety of experiencing their patients during non turbulent times.

When disaster hits, physicians become immersed in someone else’s pain and tragedy. But when they die, or get better, or move away, we are plucked out of their lives and rarely are present for any sense of closure. By then we have moved on to the next case, the next emergency.

Disjointed, unnatural intimacy.

I don’t know how to solve this problem.

For my part, I have decided the only solution is to strive for mutual disclosure. Maybe we, as physicians, can tell our stories.

We can tell our stories to those we care for,

so that they may also care for us.

By Dr. Jordan Grumet, Internal Medicine

*Re-posted with permission

Original can be found at: http://jordan-inmyhumbleopinion.blogspot.ca/2015/03/the-intimacy-gap.html

Healthcare

My First Lesson in Humility

I remember being more confident that most of my peers. The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me. Maybe it was on account of my life-long pursuit of medicine. I felt nothing but elation at the newly branded “M” and “D” that came after my name on the hospital badge. I was no longer a volunteer, no longer a student. I was a doctor. And part of that persona was walking into the unknown with a certain amount of confidence. This was exactly where I was meant to be.

A few months into internship, I admitted an obese lady with a skin infection on her thigh. I started the appropriate antibiotics and waited. My resident noting the appearance of the skin asked me to order an X-ray. I placed the order but secretly was befuddled. Why order an X-ray? What on earth was that going to show?

I was on call and busied myself with the drudgery of being the low man on the totem pole. I admitted  5 new patients. I drew blood. I did paperwork. I spent hours in front of the computer screen looking up labs and filling out charts. I forgot one thing though.

Maybe it was because I didn’t understand my resident’s clinical reasoning. Maybe somewhere in the recesses of my mind I had written the order off as something superfluous or unnecessary. To this day, I can’t explain why I failed to follow up on the X-ray of the thigh and retrieve the results. Some things may remain unexplained.

The next morning my resident and I breathlessly ran to the patient’s room at her nurses prompting. Her blood pressure was dangerously low and her temperature was sky high. My resident looked at me in a panic and inquired about the X-ray. After we stabilized the patient, we ran down the stairs to radiology and glanced at the films. Our worst fears were confirmed upon staring up at the light box: subcutaneous gas.

The patient had necrotizing fasciitis (a severe form of skin infection) and needed immediate surgery to remove as much of the infected tissue as possible. She would likely lose her limb and possibly more.

Years later, I can’t help but wonder how much better she would have done if I had seen the film the night before, and surgery had been called immediately. The patient survived either way, but by a hair.

And I learned an important lesson that night in humility. A lesson I would be taught over and over again as I journeyed through medical education and beyond.

Disease is tougher, more resilient, and far more cunning than the minds of the medical experts who struggle to tame it.

It is only to be rivaled by the human spirit of our brave patients, who battle day in and day out to survive.

By Dr. Jordan Grumet, Internal Medicine

*Re-posted with permission

Original can be found at: http://jordan-inmyhumbleopinion.blogspot.ca/2015/03/my-first-lesson-in-humility.html

Social Work/Helping Profession/Mental Health

Celebrate Social Workers

*Original blog post can be found at: http://www.pallimed.org/2015/03/celebrate-social-workers.html*

I had to share this post as a social worker myself……. Happy Social Work Month! Thank you to Allie Shukraft for writing it!

March 2015 marks two events in the world of American hospice and palliative medicine (HPM) social worker: National Social Worker’s Month and the 60th anniversary of the National Association of Social Workers, our largest member organization. This year’s theme is “social work paves the way for change.”  I love this theme because it brings me back to a conversation with a hospice social worker who told me why he loved his job and that I should become a social worker (I laughed at that point in time . . . little did I know). He said that patients and families in hospice are making their way through this dark, twisted path in the forest that is illness. They are lost and confused, and though they want to find a way out, sometimes there is none. He said his job then was not to shine a light on the path and make it easier, nor was it to show them the way out of the forest. Rather, it was to walk with them on their journey and be present.
So what paths are we trying to accompany our patients and families on as they navigate? Although our patients and families are each unique, there are some common paths that they may tread upon within palliative and hospice care. Social workers are there to meet the bio-psychosocial-spiritual needs of the patient and family, emphasis on the psychosocial. Yes, what we do overlaps with some of the roles of our other team members (I envision interdisciplinary team roles like a Venn diagram), but a social worker’s training is specialized to meet the patients and families where they are and help them determine where they want to go. As part of our Master’s preparation, our ongoing training, and our licensure requirements, we learn about human development, psychological theory, the intricate interactions of the systems in which we operate, and many more specific skills.

On Wednesday night 3/11/15, join me for this week’s #HPM Tweetchat as we take a look at the psychosocial elements of the work we all do through discussion of the following topics:

Topic 1: what are the psychosocial needs of #HPM patients and families/caregivers?

Topic 2: what is the most difficult part of psychosocial care of the #HPM patients and family members?

Topic 3: how can we measure the effectiveness of our teams at meeting these needs of #HPM patients and family members?

Join me @alifrumcally this Wednesday night at 8pm CST to explore the concept of social work and psychosocial needs in HPM.

Special thanks to Lizzy Miles, MA, MSW, LSW and the social workers and chaplain from Carolinas Palliative Care and Hospice Network for their input on these thoughts . . . they are invaluable!

Allie Shukraft, MAT, MSW, LCSWA is a reformed high school English teacher turned pediatric palliative care social worker with Carolinas Healthcare System in Charlotte, NC.  She enjoys spending time with her family and exploring the country whenever she can.  You can find her on Twitter at @alifrumcally

Photo courtesy NASW

Healthcare

Burned Out

Walter was far older than his chronological age. A mere thirteen years, he kept company with a much older crew. Doctors, nurses, and CNA’s were his constant companions. The other kids on his floor were either too sick to interact, or came and left within a matter of days. But not Walter. His heart was too weak to allow his departure, but too strong to be first in line for a transplant.

So he passed his spare time with the staff. He often duped me and the other medical students out of our pocket change with some confidence game or another. He was like a younger sibling, or maybe the hospital mascot. Everybody knew him, and everybody loved him. Unlike friends and neighbors, however, we knew the most intimate details of his medical history.  We examined his body and ordered blood tests. We were in charge of his well being.

Walter was the patient I spent the most time with during my medical school career. He was a constant presence throughout my three months of pediatrics. The last day of my rotation, the nursing staff got the unexpected call. Walter was prepped and taken to the operating room. A child had died tragically, and Walter was given a second chance at life. Around midnight my team snuck into the ICU and peeled back the curtain.

Walter was alive and well. A breathing tube snaked from his mouth and chest tubes hung from his bedside. The grayish pallor of his face had been replaced by a pink glow. I took one last look back and left the ICU. And left my pediatrics rotation.

And stepped out of Walter’s life forever.

Years later, I am struck by how many times I have repeated this cycle in my medical career. Patients come and go. Doctor is inserted at most intense moment. The patient dies, or leaves the hospital, or exits the nursing home, or moves away.  We live a life of transience.

I used to think of this as intimacy. As I get older, I question this belief more and more. For true intimacy, confidence is earned, not given forthright. It is the product of shared struggle and trust. And when someone you are intimate with dies or leaves your life, there is a period of mourning, a time for closure.

What physicians experience today is feigned intimacy. We swoop into people’s lives during their most intense moments and leave abruptly.

It’s no wonder most of us walk the hospital floors with gaping holes in our sides that only we are unable to see.

Wounded.

Gasping for air amongst the charred remains.

Burned out.

By Dr. Jordan Grumet, Internal Medicine

*Re-posted with permission. Original can be found at: http://jordan-inmyhumbleopinion.blogspot.ca/2015/02/burned-out.html

Healthcare, ICU

Decalogue of the Ministry of Health for children admitted to the Hospital  

Hola a tod@s, my dear Friends.

On June of 2013 the next document was published by Spanish Ministry of Health, Social Services and Equality:

It is the agreement of the Interterritorial Council to establish quality criteria applicable to Paediatric and Newborn Intensive Care Units (PICU and NICU) and of the National Health System, enabling to homogenize the attention, schedules visits, and protocols.

It is a very short document, which ends with a list of measures to improve the quality and warmth of the attention of children under 18 years hospitalized in Spain, and I wanted you to have the document available. 


1. Establish an institutional policy that ensures that children admitted in newborn and paediatric ICUs will be accompanied by their mother, father or family, recognizing the essential role for the income of the minor.

2. Promote the mother/father who wish can stay with the child 24 hours a day, and accompanying during painful and stressful medical tests in order to reduce their level of anxiety, without interfering in professional work.

3. In the newborn, encourage contact skin to skin and interaction with their mothers and fathers the maximum time possible, since benefits are shown for both.

4. Promote the creation of banks of breast milk in major hospitals newborn services.

5. Help the training and participation of the family in care and decision-making and inform them of their rights and of their children.

6. Promote awareness-raising, training and updating knowledge on breastfeeding and the importance of the role of the parent in the health care professional team.

7. Ensure the continuity of care during pregnancy, childbirth, and puerperium.

8. Provide information and support to mothers and fathers who have their children admitted in the Hospital.

9. Develop policies and hospital practices that favour the initiative of hospitals and Newborn friends units of mother and child in accordance with UNICEF and WHO, as the Initiative for the humanization of assistance at birth and breastfeeding.

10. Include these measures in the protocols of the cited PICU and NICU of the whole of the Spanish Health System hospitals, ensuring its compliance.

I am sorry because the full document it´s only available in Spanish. As you can see, there is a long way to go.

What about adults? From The IC-HU Project, we are creating the International Initiative for the Humanization of Assistance in Intensive Care. All together, listening to all voices.

By Dr. Gabi Heras, ICU Physician
*Re-posted with permission.
Original can be found at: http://www.humanizingintensivecare.com/2015/02/decalogue-of-ministry-of-health-for.html
Healthcare, News

I am your Doctor and this is my Humble Opinion

What is it like to be your primary care physician? How do day-to-day pressures, concerns and unfolding developments impact the one who looks after your health and wellbeing? What does your doctor feel about the responsibilities and nagging questions that are an integral part of every waking hour? What is it like to know that each routine decision is potentially life-altering to your care? Who cares about your future medical care?

Jordan Grumet’s writing builds an insider’s level of understanding. His unique delivery is simple and eloquently succinct. His potential audience is at a critical juncture in medical-political development, particularly in the United States, and his impactful prose is already vitally felt by a growing number of readers. The timing is optimal for Jordan’s writing to be published as a widely accessible collection of stories and essays.

Reverent dedication to quality diagnostic care permeates his writing and motivates Jordan to share from the head and heart. Each new essay challenges his readers to think and feel, taking on the varying perspectives of his challenging, endearing and beloved patients, and of family members of the ill or dying. Jordan’s words deepen our understanding of the unwelcome, or sometimes welcome, arrival of Death.

Jordan opines from experience, while he illustrates doctor-patient relations; doctor-colleague conduct and cooperation; and the impact that exponentially increasing forms, restrictions, technology and time commitment have on the delivery of quality care to patients. You and I and all of those in the medical system feel the impact of this government- and insurance-driven regulatory environment. More and more physicians are shutting down, opting out or simply struggling to juggle the burden of imposed digital and paper requirements, while their expertise is in medicine. Quality medical care, based on face-to-face doctor-patient relationship building, is lagging as a result. Jordan Grumet delivers this news powerfully and persuasively. His ability to do so is both timely and important.

Married with two children, he sometimes includes family members in descriptions of his daily life and medical practice. In one essay, Jordan relates how his son’s birth reawakens a depth of feeling that he previously guarded tightly as protection from the emotional impact of his work. In story after short story, Jordan reveals to us just how he is able to channel a full range of emotions, healthily and consciously, into his daily interactions.

To whom does Jordan’s writing appeal? Doctors, nurses and ancillary support workers all relate strongly to his descriptions of the front lines of medical care. Lay people who care about the future of their own medical needs, and all who’ve felt the benefits of kindly delivered care, resonate with his words. These various reading audiences either nod knowingly, based on their own similar experiences, or burst into tears as they “get it” that a physician is called to devote such an ample measure of body, heart and soul to their compassionate care.

Humility. Naked self-assessment. Doubt. Surety. Wonder. Devotion. A peek inside.
by Dr. Jordan Grumet
*Re-published with permission. Original can be found at: http://jordan-inmyhumbleopinion.blogspot.ca/