The One Healthcare Tip Everyone Should Know

I’ll never forget when I walked into the kitchen and saw my new home health patient sitting at her table with a glass of Ensure. She was just staring at it. As I came in the door, she said, “I just don’t know how I’m ever going to drink it.”

I listened as she described her recent treatment for cancer in her sternum (breast bone). She has received a heavy dose of radiation therapy that had severely burned her esophagus. As a result even swallowing her own saliva was excruciatingly painful.

She told me had already lost 15 pounds since her radiation treatment and was going to have another in two weeks. Then she said, “I just don’t know how I’ll ever get through another one. I mean, if I lost 15 pounds with this one. What’s going to happen with the next one?”

I asked her what the doctor had told her about the goal of her treatment. Would he be able to get her cancer in remission? How many treatments would she have? At what point would treatment be stopped if unsuccessful?

Sadly, she knew none of the answers.

Over the years in my nursing career I heard countless stories like these. Stories of patients going through treatments with the idea that “when the doctor wants to let me know, he’ll tell me.” What I wanted to do at this particular visit was help this patient explore her own questions about her diagnosis and treatment and see how I might help her.

Knowing that I am a nurse and take direct orders from physicians, I found myself now stepping fully into the role of Patient Advocate. This role can be at times intimidating for a nurse because it causes us at times to buck the system or go against the flow. I didn’t know how far I would need to go for her. But, her care was all that really mattered to me.

My patient struggled with the idea of questioning the doctor. “Doesn’t the doctor know best? I’m not a doctor.”

The bottom line was that my patient was doing what most everyone does — going with the flow. And, sadly, her health was deteriorating because she and I both had too little information.

At that point I reviewed her medications. She had pain pills prescribed but couldn’t take them because she couldn’t swallow. She was also nauseated and had no medication for that. Several other pieces of the puzzle were missing for this poor woman.

As we talked about her situation, she told me how weak she was becoming due to not being able to eat. She said she did her best to drink at least 2 cans of Ensure daily, but couldn’t always do it.

That’s when I realized she was not getting what she wanted or needed from healthcare because she didn’t think it was ok to question her doctor. And it dawned on me that this was happening to many people every single day.

In that moment I realized that healthcare is no different than any other product or service we buy, and we should be able to get from it exactly what we need. After all, we are paying with our hard earned dollars.

She and I talked further about her situation. I asked her what she most wanted and needed from her healthcare. She told me she wanted to have her pain controlled, quit vomiting and try to maintain her weight. She also wanted to know what the goal of her treatment was and what the doctor thought her chance of survival was.

I contacted the doctor right away and was able to get liquid medications for pain and nausea that were much easier for her to take. She and I then set about making a list of questions she would ask her doctor on her next appointment.

Here’s the questions we jotted down:

1. What is the goal of my current treatment?

2. How many radiation total treatments will I have?

3. Do you expect to be able to put my cancer into remission?

4. What would cause us to stop treatment?

5. How will we support my weight and nutrition?

6. Can you keep my pain under control?

7. Are there other side effects I should know about?

8. Are there any medications that are less expensive for me to take?

9. As of right now am I doing well or getting worse?

10.If radiation doesn’t work what are my other options?

Having gone through this process with a very special patient, I was now on a mission to be sure that all of my patients were getting exactly what they wanted and needed from their healthcare. That meant that I needed to create a simple way to educate them about how explore their own questions about their health; and also how to question their doctor to get the answers and care they needed.

I ended up creating a simple generic list of questions that anyone can review before a visit with their doctor. I really believe that sometimes we don’t know what our questions are until we have a prompt.

By reviewing these questions before a medical appointment it can help identify questions that you have. Another thing I like to recommend is keeping a notebook just for questions to ask the doctor at the next appointment. That way, you don’t have to worry about forgetting what you wanted to ask.

Here is the list of questions I encourage everyone to review before seeing the doctor.

· Do I understand the goals of my current medications and treatments (my care plan)?

· Am I sick right now and in need of a new medication or treatment?

· Am I comfortable with my current medications and treatments?

· Do I need any refill prescriptions?

· Do I want to request generic medication prescriptions to save some money?

· What would I like to have added to my medications and treatments?

· What would I like to eliminate from my medications and treatments?

· If I need a new treatment, what are my options?

· If I have a chronic illness, am I doing well or getting worse?

· Do I understand everything about my illness and my health?

By sharing this list of questions with my patients over the years I saw them become empowered to make choices that were in line with their beliefs and lifestyles. I saw them engage in their own care and understand that they had a voice in how their healthcare was managed.

Being able to help a very vulnerable group of people in this simple way gave me so much joy and satisfaction. Nursing is a profession that is all about the patient. By helping my patients find their voice and experience healthcare on their terms my servant’s heart was fulfilled.