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Incontinence Support Blog

I want to tell my doctor: "I want a second opinion."

Posted by Mens Liberty

May 11, 2013 11:00:00 AM

Medical diagnosis can be tricky – particularly when it’s your very own health we’re talking about.  So who cares if you want a second opinion?

Well the doctor’s ego might… 

And no one wants to hurt a caregiver, even your doctor.  In our polite society, we often put other people’s feelings ahead of our own.  Some people believe it may be considered “insulting” to your doctor, or at the very least “awkward”.  And it shouldn’t be – really!

So here are some “nice” ways to do it and what to incorporate:

  • Be Upfront – Don’t go behind your doctor’s back.  Your doctor will appreciate your honesty.  Those health records are your records, and the law requires doctors to give you access.

  • Say It Straight – Medicine is complicated, so try saying “I understand there are tons of studies, some contradictory, and doctors have different ways of interpreting them.  I wonder if you think I should get another doctor’s position on my situation?”

  • Be Nice – It goes a long way.  Add the nice statement, “I appreciate the time you’ve spent examining me.  I know this was a difficult diagnosis for you to call.  Seeing an additional doctor is just so I don’t sit up all night forever wondering.

What might be some of the clues or situations in which you might ask for a second opinion?
  • Being bounced around between doctors is one scenario.  Determining your exact diagnosis will ultimately assist in developing the most effective treatment.  It is SO VERY IMPORTANT!

  • Any type of diagnosis that is severe warrants asking for a second opinion - particularly diseases such as cancer.  Especially, if you have a nagging feeling that the diagnosis isn’t sitting well with you.  Trust your intuition.

  • Another reason to ask for a second opinion is trying to determine a course of action when there is more than one treatment option.  This is close to the saying “two heads are better than one.”  A reassuring opinion is worth its’ weight in gold!

Okay - so what if no diagnosis is being made?  You don’t want to lose faith in your caregiver, particularly if they are a specialist.  So a graceful request for a second opinion can potentially move you closer to further answers, and subsequent solutions.

We highly recommend that you get a copy of your records.  That way, you know what is currently recorded about you.  Write your questions and concerns down prior to visiting with the new doctor.  Having the critical information and your misgivings or concerns recorded will help the second opinion doctor focus on you.

Who to go to?  Ask your doctor - they know who’s reputable in their field, and more than likely, they want the best for you.  Or, do some research yourself.

A little known research tool is Google Scholar (http://scholar.google.com/).  With Google Scholar, you can search published books, abstracts and articles across many disciplines and sources.  This is very helpful when trying to identify a person that is active in the field that is specific to your case.

You are actively putting your health first.  Congratulations!  In addition, you are standing on the shoulders of giants when you’re able to view relevant works from academic publishers and professional societies.

One final special note:  Don’t give up any appointments with your first doctor, just in case the second opinion doctor doesn’t work out for whatever reason.  Makes sense, right?!

We wish you the best!  Know that we’re here for you, and we’re interested in you having the best health possible!

And don’t forget…  We want to hear from you!  Tell us your “Second Opinion” stories, and let’s all share your ideas!

To your best health!

Topics: doctors visit, hospital errors, medical research

Surgical 'Never-Events' Are Shockingly Common - New Study Published!

Posted by Sarah Woodward

Apr 24, 2013 1:00:00 AM

I was shocked to see this headline land in my inbox yesterday and I just had to share. We've talked about so-called "never-events" before because one of the most common "never-events" are hospital acquired infections and pressure ulcers.These two never-events are frequently linked to the use of out-dated incontinence management products like adult diapers and medically unnecessary Foley catheters.

To give you a little background, the term "never events" was introduced in 2001 at the National Quality Forum by Dr. Ken Kizer, in response to severe, largely preventable, hospital acquired conditions.  The NQF initially defined 27 conditions which were revised and expanded to 28 in 2006.

A 2010 GAO report estimated that 1 in 7 Medicare beneficiaries will experience a "never event" during their hospital stay. These events also lead to the death of almost 15,000 Medicare beneficiaries per month and over 100,000 people each year.

And sadly, improving these numbers has been an uphill battle - leading to the story below.

Surgeons Make Big Mistakes Nearly 80 Times a Week

As every doctor knows, "never-events" are the kind of medical mistakes that should simply not occur. Despite this, and despite hospital and physician risk-management efforts to prevent them, such events occur more often than people believe, according to a recent study by patient safety researchers at John Hopkins University School of Medicine in Baltimore, Maryland.[1] The full study appears in the April issue of the journal Surgery.

The study estimated that "a surgeon in the United States leaves a foreign object such as a sponge or towel inside a patient's body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week, and operates on the wrong body site 20 times a week."

To identify malpractice judgments and out-of-court settlements, researchers used data from the National Practitioner Data Bank, a federal repository of medical malpractice claims. On the basis of such data, the researchers estimate that 4044 never-events occur in the United States each year.

Surgeons between the ages of 40 and 49 years were responsible for more than one third of the events, whereas surgeons older than 60 years were responsible for 14.4%. Approximately 6 in 10 of the surgeons involved in a never-event were named in more than 1 separate malpractice report, and more than 1 in 10 were involved in at least 1 separate surgical never-event.

Medical centers have put safeguards in place to prevent such mistakes. Among other things, they have instituted mandatory "time-outs" in the operating room, during which the team is supposed to match the surgical plans with the patient on the table; they have required that surgical sites be designated with indelible ink; and they have insisted that surgical team members count such items as sponges and towels before and after surgery.

But critics think more needs to be done, including public reporting of never-events. Such reporting would not only help consumers make informed choices; it would "put hospitals under the gun to make things safer," says Marty Makary, an associate professor of surgery at Johns Hopkins and one of the study's authors.

Topics: hospital errors, proactive patients, Medicare, hospital acquired infections

Healing Technophobia among Nurses with Men's Liberty

Posted by Sarah Woodward

Dec 10, 2012 10:04:00 AM

“IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.”

“Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems,” says author John Rossheim.

In a great recent article, John delved into the relationship between healthcare and IT and how implementing better technology can support patient centered care. It’s a great message, so we’ve included excerpts from his article below. Catheter management is a huge issue where IT has made an impact through catheter removal reminders and by encouraging nurses to look at other options like Men's Liberty.

There are some great ideas in there - take a look and share your thoughts!!

Stereotypes have helped perpetuate the notion that there’s a culture clash between clinicians and IT folks, a conflict that can scuttle the implementation of an electronic records system or at least reduce its effectiveness. But with careful planning and execution, this clash can be reframed to create a working coalition of healers and technologists. Here are some principles for increasing the odds of a successful collaboration.

Time Savings Come, with Time.
Let’s start with one perceived clash that any healthcare IT implementation team must address: that a new or upgraded electronic system will take direct-care time away from clinicians, at least in the early going. “Nurses have a way of viewing anything that comes between them and the patient as a threat,” says Mary Cothron, RN, a clinical trainer and implementation specialist at Informatics Corporation of America in Nashville.

Given nurses’ heavy record-keeping burden, their concern is understandable. Among the major tasks in an average shift, nurses spent 55.7 percent of their time on indirect care tasks such as documentation, versus just 32.8 percent of each shift on direct patient care, according to a 2008 study appearing in Nursing Leadership. So it’s reasonable for clinicians to push hard for an IT implementation that on balance will give them more time with patients. “When you add something to nurses’ workload, you also have to look at what you can take away,” says Harry Jacobson, M.D., CEO of Vanderbilt University Medical Center. “Nurses already have too many tasks.”

While navigating an online recordkeeping system may initially take longer than pen and paper, a digital records system has clear-cut time-saving features, and these should be highlighted. “When you bring in electronic records, you go from not being able to find the chart 20 percent of the time to always being able to find it,” says Chris Wood, M.D., Medical Director of Information systems at Intermountain Healthcare, a nonprofit system based in Salt Lake City. “You have to remind people again and again why you’re bringing in the technology.”

Efficiencies Come with an Increased Comfort Level.
For some nurses, an even greater fear is that the simple and transparent, if inefficient, information structure of a paper chart becomes opaque when reincarnated in electronic form. If you’re having trouble locating a test result in a paper chart, you simply leaf through every page; in an electronic health record, with its nonlinear structure, clinicians worry they could run circles around that test result without ever finding it.

“Clinicians are really making a leap of faith that the same kinds of information are being communicated” through a new electronic records system, says Claire McCarthy, Director of Change Management at Kaiser Permanente in Oakland, Calif. Or, as Cothron puts it, “As a nurse I’ve wondered: Do I have it all, am I missing any piece of the picture?”

Success Arrives when Clinical Insight Informs Technology.
Clinicians are the best advocates for their own usability requirements. They can, for example, insist that screens are configurable for individual patients, while key information is presented consistently throughout the system, Cothron says. Electronic dashboards can help nurses track all the requirements of a protocol in a unified view, says Dr. Jacobson, whether the patient is on an IV catheter, a ventilator or a complex regimen of medications.

Basic patient information such as allergies, fall risk and height and weight should be visible on the nurse’s screen at all times, says Cothron, perhaps on a static banner.

Screens can also be optimized to meet the specialized needs of nurses, therapists and other clinical professionals. “Our respiratory therapists suggested that to streamline their work, we modify the documentation flow sheets so that they could consolidate their entries in one area and not have to skip around,” says Ann Filz, RN, a floor nurse and designated super user at a medical center in Clackamas, Ore. “We’re trying to limit the number of clicks that a clinician has to make in a record.”

Proof of Patient Safety Brings Instant Gratification.
Perhaps the best way to bridge the culture gap is to demonstrate to clinicians that many aspects of automation improve patient safety. Bar-coding of medications is one innovation that does just that.

Reconciling the medications of a patient who is moving between units is complex and stressful for nurses, even when the transfer is within a hospital, Cothron says. “This scares nurses to death when they don’t know what the electronic record is going to look like when viewed from the other department.”

The solution? “We use bar-code scanning for medication,” says Filz. “So if a nurse had the wrong medication and scanned the patient’s wristband, the medication administration screen will open with the alert: ‘This medication has not been ordered for this patient.’ ”

As always, the perceived risks and clear wins of automation should be presented in tandem to clinicians, to show that a system implementation will yield a net gain for the patient. “There were concerns that our implementation might pose a risk, but in fact one of the big reasons to use electronic records is that they truly enhance patient safety,” says Filz.

Ultimately the culture clash can be tempered if technologists begin to understand the clinicians’ perspective, and if clinicians learn to appreciate how the IT implementation improves patient care, especially in the long run.

Says Dr. Wood: “When clinicians have experienced time after time that IT brings an increase in functionality or efficiency, even though there’s pain in the change, they’ll work with it.”

 

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Topics: external catheter for men, hospital errors, proactive patients, nursing

Cutting Hospital Readmissions with Men's Liberty

Posted by Sarah Woodward

Dec 7, 2012 9:58:00 AM

Here is some great new information out recently from Stephen Jencks, MD, MPH.


Dr Jencks is the lead author of the New England Journal of Medicine study on the cost of readmissions to the American healthcare system. He says hospitals must look beyond the four walls of their facilities to reduce readmissions. That’s great news for us because we talk to WAY TOO MANY guys who ricochet back and forth between hospitals and home health care due to urinary tract infections. Reducing infections and readmission rates go hand in hand!

Speaking recently in Florida, Dr Jencks expanded on his previous work to convince attendees that the best way to cut hospital readmissions was to build relationships within the local community.

“The idea that it is not just that the patient leaves the hospital and goes into the community. It’s that information leaves the hospital and goes to the community, and that information comes back to the hospital from the community. This is feedback. This is how you improve what you do when you send a patient out. And if you are not securing that feedback, it’s going to be really hard to make the discharge more effective and better, yet the truth is that relatively few organizations have a systematic way of getting that feedback from nursing homes, physicians, home-health agencies and hospice.”

“On the other end, the same increasing complexity of information flow is here. You have the patient going back to the emergency service and you have information going with the patient from the home health agency or the skilled nursing facility or from the family.  And you have feedback coming from the emergency room to the organization that sent the patient, and that information may come back with the patient. Suddenly, the emergency room is now in an active dialog with the nursing home or the home-health agency or community nursing. This is a partnership. And partnerships with community organizations are emerging out of attention to readmissions. There are conversations going on between nursing homes and hospitals that weren’t going on five years ago.”

The biggest lesson is not to look at readmission as a black and white issue.  “Discharges are not something written in stone. In fact, in readmissions, the best way to reduce bad outcomes is to reduce exposure to the risk of bad outcomes,” i.e. reducing exposure to things like indwelling catheters will cut initial infection rates AND readmissions.

describe the imageFor partner organizations, “it’s not enough to put people in the back of the ambulance at 11 o’clock in the evening and shove them to the emergency room with a slip of paper pinned to them that reads, “Please diagnose and treat.”

“Understanding community is not new for hospitals. What is new is the need for partnerships within that community. The community shifts from where people flow in out to a set of partners you actively work with. That’s an enormous challenge for some hospitals. My personal suspicion is the hospitals’ ability to succeed with that challenge is going to be the difference between hospitals that really succeed over the next 10 years and those that find that it’s all too much for them.”

We’re rooting for hospitals, nursing homes, home health agencies, patients and families as they make this transition and we look forward to supporting the reduction of urinary tract infections by introducing the healthier alternative, Men’s Liberty.

Have you experienced a catheter-associated UTI recently? Looking for a healthier option that gets you out of the hospital and back out in the world living life to the fullest? See if Men’s Liberty could work for you!

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Topics: urinary management, doctors visit, hospital errors, urinary tract infections, nursing, hospital acquired infections

Is Your Hospital Trying to Kill You? Reduce CAUTI with Men's Liberty

Posted by Sarah Woodward

Oct 1, 2012 4:54:00 PM

Inflammatory headline? Yes.

True?  Sadly... also yes.

Scary fact of the week: "Medical errors kill enough people to fill four jumbo jets a week," according to a recent article in the Wall Street Journal by Dr Marty Makary, a surgeon at Johns Hopkins Hospital.

Not scared yet? Try this one on for size - "Roughly a quarter of all hospital patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America - just behind accidents and ahead of Alzheimer's disease." That's an estimated 98,000 preventable deaths a year1.

 Hospital staff - Men's Liberty

According to a recent study by David Classen published in Health Affairs, the most common adverse events are medication errors, followed by surgical errors, procedure errors, and hospital acquired infections2. The bit that really sticks out to me is hospital acquired infections because these include pressure ulcers and catheter associated urinary tract infections (CAUTI). CAUTIs account for 40% of all hospital acquired infections3. They are the single most common hospital acquired infection in US hospitals today and costs over $2 billion in additional healthcare costs each year4.

CAUTI are predominantly caused in the overuse of indwelling urinary catheters among hospital patients5. Some indwelling catheters are medically necessary, others are there for the nurses convenience and others are only necessary for a portion of the patients stay (such as when they are under anesthesia) but are left in for longer than medically necessary. In 2010, the Centers for Disease Control estimated that more than 560,000 hospital acquired UTIs occur each year and cause over 13,000 attributable deaths annually6.

 CDC report on CAUTI

Pressure Ulcers are caused by sustained pressure against the skin that prevents an adequate supply of blood from getting to the skin and underlying tissues. This problem is exacerbated by people's skin being compromised by constant exposure to moisture (what happens when they are forced to wear diapers for incontinence). Pressure ulcers are avoidable and cost the healthcare system $11 billion each year7. I won't subject you to any pictures of pressure ulcers here but if you're curious, google it. It's nauseating.

But at the end of the day, what does all this mean for you?

It means that it is entirely possible to go into the hospital for a relatively minor procedure and be released worse off than when you went in. Surely that is something we can change. For example, we can eliminate medically unnecessary indwelling catheters. Sounds simple, right? We've tried. Men's Liberty is a healthier alternative that can replace medically necessary Foley catheters. With over one million units sold, there hasn't been a single reportable adverse event caused by the device including urinary tract infections or skin injuries.

 Mens Liberty

This one change could save facilities billions and lower their infection rates. But they won't do it because the product costs slightly more up front. Product purchases and complication costs are paid out of two different pots of money within the hospital so purchasing managers see no financial benefit to them. That's a HUGE problem.

Dr Makary listed five action points for decreasing medical errors -online dashboards, safety culture scores, cameras, open notes and no more gagging - but I have one more to add. Hospitals should have at least one high ranking individual responsible for taking a broader view, to look at how small changes in one area could pay dividends elsewhere and guides decision making accordingly. Controlling healthcare costs in the long term means looking at the forest, rather than the trees.

 

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References
  1. To Err is Human: Building a Safer Healthcare System, published by the Institute of Medicine, November 1999, See online: http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
  2. Classen, David, "Medical errors in the USA: human or systemic?," The Lancet, Volume 377, Issue 9774, Page 1289, 16 April 2011. View online: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960520-5/fulltext?rss=yes
  3. Kunin, Calvin M., "Nosocomial Urinary Tract Infections and the Indwelling Catheter: What is New and What is True?" Chest 2001; 120: 10-12.
  4. Calculated from TMIT-APIC Healthcare Associated Infections Cost Calculator. Available online at: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/GuidelinesStandards/Cost_Calculators.htm.
  5. Munasinge, Rijika L. et al., "Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service," Infection Control and Hospital Epidemiology, October 2001; Vol 22, No. 10: 647-649
  6. Gould, Carolyn, "Catheter-associated urinary tract infections (CAUTI) toolkit" Centers for Disease Control and Prevention, Available at: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItooklit_3_10.pdf
  7. Reddy, M., Sudeep, G., Rochon, P., "Preventing Pressure Ulcers: A Systematic Review," Journal of the American Medical Association, 2006; l296: 974-984.

Topics: bladder control, external catheter for men, hospital errors