decisions

Your Doctor’s Advise – Misunderstanding can lead to BAD Decisions

Posted on by Michelle Fritsch, Pharm.D.
Good communication with your doctor
Let us help you avoid misunderstanding with your doctor.

Have you ever experienced misunderstanding with someone?  Did that lead you to make a bad decision?  If you had understood the original message, would you have made a different decision?

I have had two client examples this week.

Misunderstanding what the doctor said

In one instance, the doctor had said something about the pain medicine and the stomach acid medicine should not be taken together.  This person has had a long history of Barrett’s Esophagus – a severe inflammation of the esophagus cause by extreme gastroesophageal reflux disease (GERD).  To break that down, this person’s stomach acid was going back up the esophagus – the tube from the mouth to the stomach.  Normally there is a sphincter that closes to keep the acid safely in the stomach.  In many of us, that sphincter can become loose or have a condition that keeps it from completely closing.  When that happens, the acid can go back up the esophagus. Indigestion, burping, pain and/or burning in the mid chest area can result.  The acid inflames the esophagus lining.  When that inflammation becomes severe, the inflammation can lead to Barrett’s Esophagus.  So the stomach acid medicine was VERY important!

This person’s other issue was low back pain due to a herniated (bulging) disk and sciatic pain. Sciatic pain results in pain and burning from the lower back and spreading through the buttocks and the leg. It is caused by irritation of the sciatic nerve, common with lower back issues.

When this person heard the doctor say the stomach acid medicine and the pain medicine shouldn’t be taken together, the person decided to STOP the stomach acid medicine.  The sciatic pain was the ‘bigger issue’, so if both couldn’t be taken, the pain medicine took priority.  The doctor was not told.

The client heard ’these medicines shouldn’t be taken together’.  The more complete answer is, the pain medicine will make the stomach acid and esophagus irritation even worse.  There are safer pain medicine options that won’t make the Barrett’s Esophagus worse.  The person should DEFINITELY be on both a stomach acid medicine and a pain medicine. The pain medicine should just be changed to a safer option.

This was explained, and this person is now on a safer medication regimen for both conditions.

Another Misunderstanding Example

Another recent example was a man with severe vascular issues and lung cancer.

The lung and cancer doctors had together told him and his family there is no more they could do. They recommended hospice care. Hospice care was accepted.

The vascular issues caused very little blood flow to the feet.  As a result, one foot and lower leg had been amputated a few months ago. The second leg and foot are now very infected.  The foot infection is causing severe pain.  Hospice is treating the pain with morphine.  The morphine makes the patient’s stomach upset and dulls his thinking.

His wife understands that the hospice doctor is now his doctor rather than his specialists and primary doctor from before.  The hospice nurses visits regularly, but the doctor has not.  His wife is very upset that the doctor is doing nothing to heal the infection.  She also feels he is very overmedicated since his memory and decision making are slowed due to the morphine.

When we discussed goals – quality vs quantity of life – they each indicated the specialists who recommended hospice had asked that.  They chose quality.  However, they didn’t understand that this would mean a rather rapid decline with the untreated lung cancer and foot infection.  They thought he would be able to back to the things he loves like working on projects around the house and cooking.   They see a decline in quality of life rather than the expected increase.

Now they want to go back to the specialists and change their minds.  It has been six months of no curative treatment.  There is most likely no way to alter the pending outcome.

Essential Clear Communication

Healthcare visits can feel fast and pressured.  Any time there is bad news involved, it is hard to fully hear and process all that is being communicated.  These and other communication issues lead to misunderstanding of healthcare information. This is NOT an uncommon problem.

Another contributing factor is difficulty reaching the doctor after getting home to request clarification.  Most doctors are given schedules that make it difficult to squeeze in phone calls.  So, it is always best to receive, process, and fully understand the information while you have the doctor’s full attention during an appointment.

At Meds MASH and Retirement Wellness Strategies, we are your advocate.  You have guidance to prepare for medical visits by assuring you have your questions ready and the information your doctor needs organized and clear.  We also attend the visit with you by video when you want that.

After the visit, we can provide a wealth of information to further explain any new conditions or medications.  We can even contact your doctor(s) on your behalf to obtain any needed clarification.

Call today at 410-472-5078 and ask for Michelle Fritsch, Pharm.D.  Or e-mail at michelle@medsmash.com.   Check out more at www.medsmash.comor www.retirewellness.com.

BIBLICAL APPLICATION

Miscommunication and misunderstanding can lead to so many preventable problems.  I often ask this question of students in the health professions. ‘Tell me about a time miscommunication led to a bad outcome.’  Usually the answers involve people going to different restaurants or friends having an argument.  One time, while teaching active duty military healthcare providers, the example was of an international hunt for a notorious terrorist.  The terrorist had been found and surrounded, but a delay in the order to detain him resulted in his escape.  What an example!

The Bible has much instruction about good communication.

This Psalmist knows exactly how much trouble our words can cause:

Psalm 141:3 ESV

Set a guard, O Lord, over my mouth; keep watch over the door of my lips!

Our communication is instructed to build people up and turn them to Christ.

Ephesians 4:29 ESV

Let no corrupting talk come out of your mouths, but only such as is good for building up, as fits the occasion, that it may give grace to those who hear.

Colossians 4:6 ESV

Let your speech always be gracious, seasoned with salt, so that you may know how you ought to answer each person.

I know I have spoken in frustration and said words I regretted.  I know I have neglected to speak up when my support could have been very helpful to someone else.  I know I have said the wrong thing and caused more harm than good, usually out of complete ignorance or insensitivity.

Proverbs 15:2 ESV / 176 helpful votes

The tongue of the wise commends knowledge, but the mouths of fools pour out folly.

One of my frequent prayers in the morning is, ‘Lord please fill me up and pour me out today.’  I ask to be poured out with the Lord’s words and attitudes and sensitivities.

Psalm 19:14 ESV

Let the words of my mouth and the meditation of my heart be acceptable in your sight, O Lord, my rock and my redeemer.

I certainly can’t be trusted to do this on my own, but with the Lord’s guidance, excellent communication can make a huge positive difference in the lives we meet!

Blessings,

Michelle

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Perspective

Wrong Assumptions lead to Bad Medicine

Posted on by Michelle Fritsch, Pharm.D.
Perspective
Avoid wrong assumptions that lead to incorrect actions.

When was the last time you made and acted on wrong assumptions? It is so easy to do. You see something from your perspective and your mind fills in the details of the who, what, when, how, and why. It’s often long after you have acted that you are provided with a different perspective that makes the entire situation look different.

A quick, fun example is in this picture. Another proof that I am a geek. I get such a kick out of these pictures.  If I believed my eyes I might run in to help the poor guy being lifted into the air.

This happens in healthcare, too. Keep in mind, the provider that is making decisions in the emergency department or the hospital usually knows VERY LITTLE about you. Any information you or a loved one or friend can give is all they have at first.

One day, hopefully soon, these providers will be able to access your medical records and make much more informed decisions. Right now, your doctor has to be contacted then the information sent to the hospital. If it is the weekend or an evening, that can take hours to days. The information then needs to get to your hospital provider from the fax machine or the electronic messaging system. Even then, there might be important information about you that is not even in your doctor’s record.

This leaves those of us making decisions about your care to rely heavily on what we see right now.

I have seen SEVERAL examples in the last few weeks of an older adult reaching medical care confused. The quick wrong assumption has been that the person has dementia. When confused, behaviors often change. A confused person can yell, pull at catheters and IV’s, try to get out of bed, and generally not cooperate. Since the assumption has already been made that dementia is the cause, calming medications are given. These then assure further confusion (but calmer) and make it very hard for the person to get to a point of no confusion.

What can you do to prevent wrong assumptions?

  1. Carry in your wallet a list of your:
    1. Allergies
    2. Medications
    3. Diagnoses
    4. Emergency contact information – name, phone number(s)
  2. If you are accompanying someone to the hospital who is newly confused, explain this to the medical team. Help them understand what this person was like before this event. They need to know the ‘baseline’. If this person was living independently, driving, managing their finances the team needs to know that. If this person was unable to do those things and was getting frequently confused at home, the team needs to know that.
  3. Share any known history about the current event. If you have been feeling worse and worse for the past three days, make sure they know that. If you have been having pain, explain that including what it feels like, how often you feel it, what makes it better or worse.
  4. If you have been taking different medications for the past few days, make sure they know that. This often happens when we are in pain or have a cold. We take over-the-counter medications or left-over medications from prior prescriptions. These can cause confusion when mixed with our normal medication regimen.

Speak Up

Again, I have seen several instances in the past few weeks where assumptions are made when someone gets to the emergency department or hospital that make a situation worse.

  • In one instance the person’s confusion started as soon as a particular medicine was given. The family member noted that but didn’t speak up. Then medications were added to treat the confused behaviors. We are still trying to taper off of those medications and get this person independent again.
  • In another instance, the person had a urinary tract infection. These are famous for making older adults confused. But since no one was there to explain how odd this confusion was for this person, the team assumed this was normal and didn’t find the infection for a while.   By then, a couple of medications had been added to treat the confused behaviors. It will take us weeks to taper her back off of these medications.
  • In a third instance, the collection of pain medications given after a surgery left the person sleeping most of the day and unable to think clearly. The spouse was dutifully giving the prescribed medicines around the clock. The wrong assumption made here was that this very healthy person over 60 could handle these medications like someone in their 30’s.
  • One more instance involved using a medication to treat the side effect of another medication. The second medication (the one used to treat the side effect) is on a list of medicines to avoid in people over 60. Rather than treat the side effect, it made the person nearly unresponsive. In this case, as in several of the others, rather than treat the underlying issue, wrong assumptions were made and actions were taken to treat the symptoms without understanding the back story.

Why ‘Bad Medicine’

Just a side disclaimer. When I was contemplating this blog I saw it as a chance to use the terms, ‘Bad Medicine’. I am a big Bon Jovi fan. I am also a pharmacist. So, I have to admit I love the song, ‘Bad Medicine’.

For more information about how to protect yourself from wrong assumptions leading to bad medicine, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

I can think of a lot of bad assumptions leading to bad decisions in the Bible. One of the first is Eve’s decision to eat the apple. The Israelites made bad assumptions continuously. A few that come to mind are thinking slavery would be better than ‘suffering’ in the desert; people in lands they were to conquer were too mighty to overcome; Moses was not going to return so a golden calf was needed. The list goes on.

So, how often do you make bad assumptions? I suggest we all do it every day. We don’t act on all of them. I don’t think we realize most of them.

I am consulting right now in a place that serves a highly diverse and unique population of people. Assumptions about gender, culture, religion, socioeconomic status, or just about anything will quickly lead you down an incorrect path. It has been an adventure of constant striving to avoid any assumptions.

These verses are good ones for me to remember each day:

Proverbs 18:2 ESV

A fool takes no pleasure in understanding, but only in expressing his opinion.

Matthew 7:1 ESV

“Judge not, that you be not judged.

Proverbs 25:8 ESV

Do not hastily bring into court, for what will you do in the end, when your neighbor puts you to shame?

Bad assumptions and temptations to act on them are one more test.

As I understand the Word, truth trumps all of the assumptions. Love trumps all of the wrong actions.

1 Corinthians 13:6 ESV

It (love) does not rejoice at wrongdoing, but rejoices with the truth.

1 Corinthians 13:7 ESV

Love bears all things, believes all things, hopes all things, endures all things.

The laws in Deuteronomy give us good advice even here in 2016.

Deuteronomy 17:13 ESV

And all the people shall hear and fear and not act presumptuously again.

I encourage you (and me) to guard against assumptions and focus on truth and love.

Blessings,

Michelle

Medicare Open Enrollment – Which plan type for you?

Posted on by Michelle Fritsch, Pharm.D.
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October 15 to December 7 is your window to select a Medicare plan. Let us help.

I find Medicare and Medicare Open Enrollment to be very confusing. Do you? Let’s spend the next two weeks trying to better understand your options and guide you through the Open Enrollment process. I highly encourage you to delay your final decisions until we walk through this process and you compare your options.

The first big decision is which TYPE of insurance coverage is best for you.

Main TYPES of insurance coverage options over age 65

Original Medicare – When you turn 65 and meet eligibility criteria (use this link), you can have Medicare Part A, Medicare Part B, and Medicare Part D. Medicare has a list of items they do and do not cover at this link. Medicare covers part of the expenses, and you pay the rest through your copay and deductible.

  • Part A covers hospital, long term care, home care, hospice, lab tests, and surgery.
  • Part B covers doctor visits, other healthcare provider visits, outpatient care, durable medical equipment, some prevention, and home health care.
  • Part D covers medicines.

Medigap – This is a supplemental insurance to go with your Medicare Part A and Medicare Part B. Medigap will cover some of the copayments, coinsurance, and deductible expenses not covered by original Medicare. You purchase a Medigap policy through a private insurance company. You will pay a monthly premium for this co-insurance.

Medicare SELECT – Medicare SELECT is a managed care version of Medigap. It is the health maintenance organization (HMO) of Medigap plans. These plans contract with specific provider groups for a lower fee. So, they are typically less expensive. Be sure your provider or a provider with whom you are comfortable is participating before you select this type of plan.

Medicare Advantage – This is also known as ‘Medicare Part C’. Medicare Advantage plans are private insurance plans that you can select IN PLACE OF Medicare. They have similar coverage to Original Medicare and can have additional benefits as well. These have a wide range of prices.

A Medicare Medical Savings Account Plan is a high deductible Medicare Advantage Plan with a bank account. The plan puts money from Medicare into the account, and you use that money to pay for Medicare-covered expenses. This limits your out-of-pocket expenses to meet your deductible.

NOTE: you cannot have both a Medigap and a Medicare Advantage plan. You can have one or the other.

Other – You might have insurance through your former employer, insurance through special programs, Tricare, Veteran’s benefits, Indian Health Service plans, or other unique plans.

Medicare resources to help you

The Medicare website has a list of eight questions to consider when you are thinking about changing plans. You can find them at this link.

Next week we will talk about the tool(s) available to you to help you compare your plan options. These will let you predict your costs over the next year. You can compare several aspects of the types of plans you want to consider. I encourage you to compare your options before making your final decision. I’ll walk you through it step by step.

For more information about your Medicare options, contact us at www.medsmash.com/contact. If we can’t answer, we have some colleagues who are experts in the field.

BIBLICAL APPLICATION

Medicare is not the only area of life where there can be a lot of confusing messages. I have teens.   I know just a few of their areas of confusing message are:

  • What to wear
  • How to act

Many of my recent pharmacy students are working their way through messages about:

  • What job to choose
  • How much of their income to spend on houses, cars, vacations
  • When to start a family; or whether to start a family

Many of my peers are sorting through messages about:

  • Helping children with college and career decisions
  • How much independence to allow teen children
  • Preparing for empty nest and soon retirement

My patients are working through message about:

  • Living at home vs. a senior living community
  • Options to move in with children when assistance is needed
  • Activities that enhance quality of life and keep them active

And we know there are countless people struggling with even more life-altering decisions surrounded my many confusing messages.

So, where does the truth reside?

John 14:6 NIV

Jesus answered, “I am the way and the truth and the life. No one comes to the Father except through me.

Psalm 145:18 ESV

The Lord is near to all who call on him, to all who call on him in truth.

Not to sound too pious, God is with you always. Whether you ‘feel’ His presence or not, He’s there…with you…always! When the messages from the many sources are confusing, you can just ask.

Matthew 7:7-8 ESV

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.  For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened.

When the messages are all confusing, ASK!

Blessings,

Michelle