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Planning Considerations for Elder Orphans and Solo Agers

8/6/2021

 
(PAST EVENT)
Free Upcoming Virtual Event

Planning Considerations for
Elder Orphans and Solo Agers

Wednesday, August 11th, 2021
1pm PST on Zoom
Join us for a riveting virtual panel discussion with Sima Kahn, MD of Healthcare Advocacy Partners, and Lisa Mayfield of Aging Wisdom. 

We will discuss who solo agers are, the intricacies and issues of life planning for solo agers, and how to choose a healthcare power of attorney that you can trust with your decisions. 

Planning ahead is essential for the well-being of solo agers, and there is no better time than now to begin the process of managing your own care, choosing your support community, and setting yourself, and those you love, up for success.  
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Twelve million adults over age 65 live alone.
That is 27% of the population–the highest rate in the world.
​The majority are women.
By age 75, the rate of women living alone rises to 44%.

-- Sara Zeff Geber, Forbes
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Sima Kahn, MD
Founder
Healthcare Advocacy Partners

In 2009, Sima founded Healthcare Advocacy Partners to fill a critical gap in our healthcare system. A board certified physician, Sima Kahn has always been a passionate advocate for her patients. 

With 25 years of Obstetrics and Gynecology practice, Sima’s breadth of clinical experience has given her a deep understanding of the complexities of the medical system.
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Lisa Mayfield
Founder and Co-Principal
Aging Wisdom

Lisa Mayfield founded Aging Wisdom® in 2003. She is trained and licensed as a mental health counselor, geriatric mental health specialist, and is a certified Aging Life Care Professional. 

Lisa brings over two decades of experience supporting and finding hope for individuals and families impacted by Alzheimer’s disease and related dementias. ​

The Importance of End of Life Planning

9/18/2020

 
Several months ago, at a time of relative innocence, we were only thinking about one pandemic.  Then, with the murder of George Floyd, the world erupted and a second pandemic - racism -  became much more clear.  (See my last newsletter)

Having read this article several months ago, I had planned to write a newsletter about it then, but the news of the day was much more important. Circling back, I want to reconsider the article, and how poorly prepared most of us are for end of life care.  

Fearing COVID-19, and ventilators, older people alter their living wills
By Judith Graham - The Washington Post / Seattle Times

​COVID-19 has thrust this knowledge into our collective consciousness, and has helped some people make decisions for themselves that they had not done previously. In the last month alone, I have had 2 people in my life about to undergo surgery who were unprepared for end of life decisions.  They had no healthcare power of attorney, no durable power of attorney for finances, and one of them had no advanced directive accessible to anyone who might need to see it.

I now ask: What if you got COVID-19 and had to be on a ventilator? Would you want that? Have you confided to anyone close to you about what your decision would be?  

Most of us are going to answer no.

Until approximately 5 years ago, I thought that the way my family had dealt with end of life planning was normal (I can hear my siblings laughing to think I believed anything our family did was “normal”). 
  • My father had a pension from the university where he was a professor, and he was able to buy extra years so that he received close to his salary after retirement. 
  • My parents had filled out a very explicit advance directive long before it was needed. 
  • A healthcare and durable power of attorney was in place. 
  • My parents had set up a family trust.
Most interesting of all, I remember when I was in high school, my parents would sit us down around the dining room table to discuss what each of us three kids would get when they died. (My poor brother, being 6 years younger than me, got the short end of the stick.) Eight years later we sat down and repeated this discussion when we were all more mature. It did not feel morbid or scary, it was just normal.
​I have since learned that this is unusual. What it did for me was to make the subject of end of life not scary. My husband’s story is 180 degrees from mine. 

When my husband's father died prematurely and unexpectedly, there was nothing in place to guide the family, including no life insurance. Now that is scary. Thankfully, it made him proactive as opposed to avoiding the topic altogether.

Now that we are all faced with the possibility of COVID-19  and the uncertainty of how we will fare with this disease, I would like to make some suggestions. 

Here is what everyone should have in place:
  1. Healthcare Power of Attorney (also called healthcare proxy or HCPOA). This is someone who knows what your decisions are, that you trust, and that you are confident will rise to the occasion and be able to make decisions about your health when needed.  In Washington state where I live, you can get HCPOA documents online.  Once you have designated your proxy, and have had someone witness it, you are prepared.  ​
In Washington, our HCPOA does not need to be notarized, although I do recommend that you take this step.   If you are traveling to a state that requires notarization, you will already have it in place. 
         
Please note that I function as a healthcare proxy for those who do not have or do not  want a family member or friend to serve in that role. If you are interested in learning more, contact me.
  1. Durable Power of Attorney (DPOA) for financial matters. This is someone who will uphold your wishes in regards to your estate, large or small, if you are no longer able to manage. Often this is not the same person as your healthcare proxy, but it can be. In Washington state, DPOA forms are also online, available to all who want them.
  1. Advance Directive (also called a Health Care Directive or Living Will). This important document lets other people (family, friends, medical staff) know what you want to be done in terms of medical intervention if you are not able to speak for yourself. Do you want to be on a ventilator if needed? Does it depend on the circumstances?  Do you want CPR done?  It will ask a whole host of questions that are better to figure out before the situation arises. ​
Especially now.

There are many options online to help guide you in this. You can see a previous newsletter I wrote on End of Life Planning here, or check out these resources for more information:

           Know your Choices, Ask your Doctor
           Honoring Choices Pacific Northwest
           Choosing Wisely
           WA End of Life Coalition
           5 Wishes
           The Conversation Project
           Death over Dinner

I am happy to schedule a time with you
to explain your options and help you with your decision making process.
  1. POLST--Physicians Orders for Life Sustaining Treatment. This document needs to be signed by your doctor and is most appropriate for those with an illness or who are quite elderly. 
  1. A Will. I would be remiss if I did not mention a will.  A will indicates what you want to happen to your possessions, especially money, real estate, and valuables once you die. Remember those discussions around the dining room table I mentioned earlier? Those discussions allowed us to hash out who got each item in my parents’ house. ​
When the time came, the three of us sat on the dining room floor with all of the small items around us, drew straws for who would go first, and then picked the thing we wanted most.  We did this in order until there was nothing left any of us wanted. We did not follow what was specified in the will exactly, but we were all happy with the outcome, and we knew that was the main aim of our parents.

For those with minor children, you must make a plan for who will raise your children if both parents die, and how the money will be dealt with. This requires a lawyer, and should have been done yesterday.

All of these documents should be easily accessible, and a copy should be provided to those you have designated. 

Remember, if you need coaching or counseling about what to do or how to make these decisions, I am here to help. 

​In the meantime, stay masked, wash your hands, maintain physical distance, be kind to each other —you know the drill.

Doing All I Can to Heal

7/8/2020

 
I have been trying to write this newsletter for a month now, but the despair of this moment we are in has kept me from doing it. What can I say that every single business / celebrity / political figure / news reporter who is worth anything hasn’t already said?

Racism is an evil. Racism is a public health emergency.  There must be a change in how we police our communities.


I have partly kept my sanity by watching the late-night comedy shows. Their truth telling, as well as their ripping to shreds of the current administration, are deeply satisfying. I am heartened by all the changes happening that are so long in coming—and those changes are not nearly enough. I think the fact that we are all captive audiences due to the pandemic has helped white people see in a way they have previously chosen not to.

I have read and watched videos of many anti racism scholars, writers and speakers.
​
What I Recommend

Ijeoma Oluo - So you want to talk about race
Ibram X. Kendi - How to Be an AntiRacist
Robin DiAngelo - White Fragility
I especially recommend this absolutely stunning and moving impromptu sermon by author Kimberly Jones.  Jones gives a powerful, eloquent speech that explains in detail why this is happening (racism across 450 years) and the difference between protesting, rioting and looting in 2020. 
And this article in the New York Times, written by Darren Walker, president of the Ford Foundation.
​
Are You Willing to Give Up Your Privilege?

Philanthropy alone won’t save the American dream.
​

This is something I have been thinking and talking about to my peers, my family, and my community. What am I willing to give up? 

I have been thinking about it in a very concrete way.  As a physician, what would I be willing to do (or to give up) had I been or if I should be present when someone is calmly snuffing out someone’s life? 

I am committed, essentially programmed, by an inborn quality and by my medical training, to save lives, to do all I can to try to heal.  Like me, this is true of most healthcare workers. 

This is why you have seen such incredible sacrifice on the part of all healthcare workers to take care of people with COVID-19, when that care becomes a risk to themselves, their own families, and their communities.

​
What am I willing to give up?

I am willing to give up the ease of access I have to the highest level of medical care if it means that everyone now has access to life-saving and preventative medical care.

I am willing to pay higher taxes if it means we have social services for all that need them—housing, mental health services, food, and a host of other needs.

I am  willing to stand up to systemic racism and violence against black and brown bodies to ensure that we all have equal opportunities in this life. 
 
 Am I willing to give up my life?
This is the scene I replay over and over in my mind. Is there a chance that a 60 something white woman, a physician, could have used my privilege to get this to stop before it was too late, without getting shot? In my screenplay I am successful. That’s the benefit of me being the author. 

Today I watched this clip from Democracy Now.
Noura Erakat, a well-known Palestinian human rights lawyer who teaches at Rutgers, is interviewed and speaks passionately about her cousin who was murdered at a check point in the West Bank. It reminded me of “home."

Her cousin bled for 1.5 hours without being taken to a hospital. The same question ran through my head. If I had been there what would I have done?


I can add my voice to the many who have said racism is a health emergency. We are all dying from it. Are those of us who have it willing to give up our privilege?  Are you? The answer has to be yes.

I Can Help

4/20/2020

 
As I work from home, I've had more time to reflect on the challenges we all face during this time of social upheaval.  While my life hasn't changed significantly, I often work from home, I know that it has upended the lives of my friends and family.  

It is finally clear how fragile our healthcare system is, and that our leaders are struggling to meet the demands of this pandemic.  We all feel worried, nervous, anxious, and overwhelmed. While there is a breadth of daily information on aspects of the outbreak, it isn't always clear how that may affect you in your personal situation.  

This is where I can help. 

As a healthcare advocate, I want to be there for you and your family, to answer your specific questions, and to provide guidance, research, answers, and compassion.  Whether you are facing pregnancy during the coronavirus and have concerns, or you are caring for an elderly parent and want to ensure you are both staying safe, or you are having health complications and feel you aren't being heard.  I want to help you.  

I am expanding my services to include 
one-hour consultations to provide answers to any immediate questions, offer counseling and guidance about your concerns, and research options and opportunities to ensure you feel secure in your health, and the health of those you love. 

Schedule your session today.  I am here for you.  

Schedule a Consultation

The Intervention

1/17/2020

 
I hope everyone had a good holiday season!  I am back to the routine, despite the weather. We had a tiny amount of snow in Seattle, not even half an inch in my neighborhood.  Snow causes this city to slow down to a crawl and schools close. This gave me the opportunity to stay indoors and catch up on work and reading.  

When I started writing about healthcare, one of my first newsletters addressed “going upstream." One of the up-streamers I read about was Dr. Jeffrey Brenner in Camden, New Jersey. He developed a model of care, almost 20 years ago, that featured a very intensive intervention for the most vulnerable people.  Dr. Brenner was highlighted in Atul Gawande’s article for the New Yorker “Hot Spotters” (which is Gawande’s term for up-streamers.)


Dr. Brenner's hypothesis was that this intervention would save the healthcare system money by decreasing hospitalizations and emergency department use.  The goal was to improve overall health status while decreasing the use of resources.

However, my reading this week led me to this article: 

Reduce Health Costs By Nurturing The Sickest? A Much-Touted Idea Disappoints
By Dan Gorenstein and Leslie Walker - January 8, 2020


As reported in the article, economist Amy Finkelstein began a randomized controlled trial at the Massachusetts Institute of Technology in 2014. Finkelstein wanted to see if Dr. Brenner's intervention was working.  The results showed no effect in terms of the rates of hospitalization or money saved. To say this is disappointing would be an understatement. However, it made me think about the goals of the intervention, and what those goals say about our medical system, as well as society in general.

I agree that the cost of care needs to be sustainable, but shouldn’t the primary goal be better health and better life? It seems to me that the type of intervention done by Dr. Brenner, which dealt with evidence-based addiction treatment, housing, and mental health services, takes a few generations to show cost savings. Even twenty years may not be enough to show the effect of addressing everything that contributes to the cycle of poverty, addiction, and poor health.

One way to combat this is by addressing income inequality in our country.  Current thought suggests that a guaranteed income would go a long way to solving many poverty-related health problems. Even more importantly, it has a great answer to the question of how we pay for it.  
"We are the wealthiest nation in the world. The question isn’t, can we pay for it? But, do we want to? This question is really about who we fundamentally want to be as a nation. Do we want to ensure that everyone has access to the basic human rights that cash can enable? Or do we want to continue to be a country where people are saddled with medical and education debt, working multiple part-time jobs to make ends meet, and living on the street because the rent’s to damn high?"

‘Let’s Give Them Money’: Could Guaranteed Income Be a Solution to Wealth Inequality?
​​Let's tie together the two issues: how does income inequality affect health equity? You will see that drug addiction and healthcare access are cited as major problems.
“It is simply unacceptable in a country as wealthy as ours that so many people lack sufficient income to pay for health care, housing or even food,” Besser asserted.  “We need to address income inequality if we truly want everyone to have a fair and just opportunity to live the healthiest life possible.”

How Income Inequality Affects Health Equity, Patient Experiences
​And finally, there is evidence that increasing the minimum wage has a tremendous health benefit: it results in a decrease in suicide rates. Of course this health benefit comes at a cost. I have no idea if the cost/benefit ratio pencils out, nor do I care. I want fewer people to die by suicide. This is what I mean about realigning our goals and metrics for the healthcare system. Sometimes the right thing costs more money.
"When controlling for changes in a state’s economy and welfare policies, the researchers estimated that a $1 increase in the minimum wage corresponded with a 3.5 percent decrease in the suicide rate for those with a high school education or less. Without some of the controls, the decrease in the suicide rate was 6 percent. The effect was most pronounced during times of high unemployment.”

Minimum Wage Raises Could Lower Suicide Rates, Study Says
Perhaps you'll agree that cost alone is not the measure we should be using. Some of our neighbors will need more help than others. And it benefits all of us when everyone is supported.

I would love to know what you think about this topic. As always, I welcome your comments.  

Cuban Healthcare

10/11/2019

 
During a recent weekend, I spent some time with a visiting poet and author, Aurora Levins Morales. A native Puerto Rican, she spent quite a bit of time in Cuba as a child, but now calls the San Francisco Bay area her home. In 2017, Aurora suffered a stroke after several previous head injuries, and underwent rehabilitation in Cuba.

When Aurora described the care she received in Cuba, and the laws regarding care of people with disabilities, I almost cried!  It was so superior to what we have in the USA. Health Advocates spend so much of our time trying to figure out how to get the best services for our clients, services that should be available to all. I decided I had to write about it. Naturally, the story is a bit more complex than the rosy view I imagined.

The Cuban Constitution guarantees protections for workers who have a disability, illness, or just due to advancing age. In the case of their death, those same protections apply to their family. The state protects “through social assistance, the elderly without resources or shelter, and any personnel unfit for work who lack family members in conditions to render assistance”. There are laws guaranteeing a safe workplace, medical care,  subsidies, and retirement in case of temporary or permanent disability. The free medical care for all in Cuba is legendary.

Cuba has the best health care in any Latin American country.  Their infant mortality rate is better than ours, and despite the negatives, they have a similar life expectancy to us in the US. The negatives cannot be ignored, however. There is crumbling infrastructure, poorly paid doctors, and the system is further stretched by doctors who are sent throughout Latin America, where they can make better pay, leaving those at home to work harder for less money.

And, despite the glowing Cuban Constitution, life for those with disabilities is not so good. Although the Cuban State guarantees the right to free education without discrimination, there is no educational policy nor laws designed to protect people with differing abilities.

According to official figures, approximately 3% of the Cuban population lives with some limitation that keeps them from participating in the labor market, and as a result, they cannot access the funds to confront the many obstacles they face in life.

Task for Alejandro Castro: Protecting Cuba's Disabled by Juan Juan Almeida
Though we enjoy some benefits, persons with severe disabilities often feel neglected and marginalized when it comes to this issue. Our limitations also make it more difficult for us to find a solution to the problem.

Being Disabled in Cuba: Waning Dreams by Mercedes Gonzalez Amade ​​

Even more disturbing is the rise of medical tourism where foreigners see a completely different medical system than most Cubans do.

Cuba, despite its famed legions of highly trained doctors, is no health-care paradise. Most hospital facilities for Cubans have peeling paint, missing light bulbs, and electrical and water outages.

​Doctors, short on supplies, are forced to reuse latex gloves, and patients bring their own sheets for beds. Medicines are scarce, in part because of the long-standing United States embargo against the island. The island's tourist facilities, however, are another world. 

According to Cubanacan Tourism and Health, the umbrella organization charged with promoting Cuba's health tourism facilities, the island last year attracted 3,500 health tourists, a number that is growing by 20 percent a year.


Promise of Cures lures tourists to Cuba by Laurie Goering

On the flip side, there are positive stories. This one is written by a doctor who went to medical school in Cuba. He is answering, from his point of view, the question “is the Cuban healthcare system really as great as people claim?

The Cuban healthcare system, borne out of its revolutionary socialist ideology, regards accessibility to healthcare as a fundamental right of its citizens. It focuses heavily on a preventative approach to medicine and offering the simplest check-up to the most complex surgery, free of charge. Dental care, medicines and even home visits from doctors are all covered by the system.

Is the Cuban Healthcare System really as great as people claim? by Rich Warner

My conclusion is that Cuba is not nirvana when it comes to healthcare, and the situation for those with disabilities is not as great as you would think based on the constitution. So, while I am disappointed, there are some positive steps worth noting. I feel incredible pain and anger about the difficulties I have in getting even meager services for my clients. I can only imagine how they feel having to live it.

We still have so much work to do to make it the system we all want to live in. Do you know anyone who has experienced the medical system in Cuba? I’d love to hear more first hand stories.  

Best of Health,
 
Sima Kahn, MD

Founder, Healthcare Advocacy Partners

Harvesting Healthcare

10/2/2019

 
It’s hard to believe how time flies; we are rapidly approaching the end of October!

Lately I have been thinking about what compels us to do what we do.  Where does our drive come from?


About 10 years ago I went to a conference given by Rachel Naomi Remen, doctor and author, who is a pioneer in the field of clinician well-being. I had read some of her books (Kitchen Table Wisdom and My Grandfather’s Blessings) and realized there were other physicians who felt like I did. One of the exercises she did during the conference was to ask participants how old they were when they first realized they wanted to take care of others: less than 5 years old, less than 10 years old, etc. Almost all of the physicians and nurses at the conference fell into the years between 5 and 10. I was younger than 5, and this realization led me to become a doctor.  I also became a healthcare advocate when I saw the healthcare system failing to take care of us.

Some of my most profound moments of change have happened when I become aware of injustice, inequity, or crimes against humanity that are committed in the healthcare arena. I was devastated when I read a 2007 blog post by Anna Baltzer, a Jewish American woman working to end the occupation of Palestine. Her friends were trying to take their 6-month-old baby, who was having trouble breathing, from their Palestinian town to their Palestinian hospital in the West Bank. They were stopped at Atara checkpoint by an Israeli soldier who kept them far longer than was necessary, causing the baby to die at the checkpoint. 

Earlier this year my book group read Never Let Me Go by Kazuo Ishiguro. This dystopian science fiction novel is about (spoiler alert!) a world where human clones are created so they can donate their organs as young adults. The book was incredibly distressing, and I was deeply affected by it. This is the epitome of medical care gone awry. But it’s just a novel, right?

Yes, it’s a novel, but actually, organ harvesting is happening right now. The difference is that people are not being cloned for the purpose. On June 17, 2019, the China Tribunal delivered its Final Judgement and Summary report on forced organ harvesting from prisoners of conscience in China.

According to the tribunal, China has been accused of organ harvesting since 2000, when it was forcibly removing the organs of death row prisoners. China claimed it was voluntary to redeem prisoners for their crimes, and supposedly stopped in 2015. However, organ transplantation has increased tremendously in China, and medical tourists have been going to China to purchase organs. There appeared to be a larger supply of organs than could be explained by executed criminals alone, and the tribunal set out to investigate.


The summary is:
“forced organ harvesting has been committed for years throughout China on a significant scale and that Falun Gong practitioners have been one - and probably the main - source of organ supply. The concerted persecution and medical testing of the Uyghurs is more recent and it may be that evidence of forced organ harvesting of this group may emerge in due course. The Tribunal has had no evidence that the significant infrastructure associated with China’s transplantation industry has been dismantled and absent a satisfactory explanation as to the source of readily available organs concludes that forced organ harvesting continues till today.”
The estimate is that hundreds of thousands of people have been used as organ donors, and that the victims do not survive. Nor is there any intention that they survive, as surgeries include operations where hearts and kidneys are removed for transplant.
“In regard to the Uyghurs the Tribunal had evidence of medical testing on a scale that could allow them, amongst other uses, to become an ‘organ bank’. The world is already watching their interests and their geographical location – although very large - may render it possible to lend them support more easily than for the Falun Gong who are dispersed throughout the country.”
They go on:
“Governments and any who interact in any substantial way with the PRC including: 
• Doctors and medical institutions;
• Industry, and businesses, most specifically airlines, travel companies, financial services businesses, law firms and pharmaceutical and insurance companies together with individual tourists, 
• Educational establishments; 
• Arts establishments 
​should now recognize that they are, to the extent revealed above, interacting with a criminal state.”
As it is, the Uyghurs are being subjected to incredible oppression, human rights abuses, forced into re-education camps, and what are essentially concentration camps. The murder of humans, used as donor banks for the lives of others, is unconscionable. It is the most heinous contamination of the discipline of medicine. These are truly crimes against humanity.

This Uighur Journalist Is Bravely Fighting a Homegrown Cultural Genocide

Gulchehra Hoja has dedicated her life to protecting her people, who are being tortured for their religion and identity
​

​Article by Jennifer Chowdhury

So why am I devoting an entire newsletter to this? Because sometimes the highest form of advocacy for health is political action.

Here are some things we can do:

• Discourage anyone from traveling to China for organ transplantation
• Spread the word
• Educate yourself about this issue
• Write to your Congressional Representatives when an issue like the Uyghur Human Rights Policy Act of 2019 comes up for a vote (it was passed in the Senate and has been introduced in the House.)
• Support local Uyghurs wherever you are—not a single family I know has been spared the disappearance of at least one relative.

“When we know ourselves to be connected to all others, acting compassionately is simply the natural thing to do.”
― Rachel Naomi Remen
To the health of everyone everywhere.
 
Sima Kahn, MD
Founder, Healthcare Advocacy Partners

Patient Empowerment

9/12/2018

 
Happy end of summer everyone!

The west coast has had so many smoky days!  The fires have stretched from British Columbia to California, leading to skies that are worse than in Beijing! Thankfully, the sky is clearing, and hopefully our end of summer will not disappoint.
I have been thinking about patient empowerment this summer, and what what it actually means to truly empower someone.

The European Patients’ Forum says:
Patient empowerment is a process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important.

The World Health Organization defines empowerment as: 
“A process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.

They go on to say:
Four components have been reported as being fundamental to the process of patient empowerment:
1) understanding by the patient of his/her role 
2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider 
3) patient skills
4) the presence of a facilitating environment.
​

I think we can all get behind this,  but what does it mean in real life? An example:

A woman had cancer that had been successfully treated once, and then had a recurrence, also successfully treated. She then had a second recurrence and had participated in several clinical trials, none of which were adequately treating the disease. When presented with options for further treatment, there was no weighting of the different options, no side-by-side comparison of the efficacy, risks, benefits, and comparison to non-treatment. And that age-old question that doctors hate and patients continue to ask did not come up “what would you do if it were you?”

This was/could be presented to her as evidence of patient empowerment—she was completely free to make whatever decision she wanted. But it was missing some vital parts of what is required for true empowerment:


2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider
AND
4) the presence of a facilitating environment

With 3 or 4 choices thrown out and not enough information to understand them, how is that empowerment? Further, the opinion of the doctor is valuable—I have yet to meet an oncologist who didn’t have an opinion about how they would move forward. They may not tell the patient, but it is there. Even the information they don’t know is helpful, because the patient can move on to other criteria to make a decision.  Such as how much is this going to hurt or cause other side effects that negatively impact their quality of life?

In terms of a facilitating environment, this is a place a healthcare advocate can be truly helpful. Exploring the patient’s priorities and understanding their risks and benefits can provide the environment for engaged decision making. Ideally,  the medical team is part of this process, but if not, healthcare advocates can fill the gap.

It is not empowerment to feel lost at sea. That is why we do this work.
​

As always, I would love to hear from you about your thoughts.
Sima

2018 NAHAC National Conference

7/20/2018

 

Our 2018 NAHAC National Conference is coming soon!

Register Here
Featuring Keynote Speaker Dr. Gary Jacobs  
Advocacy as a Public Health Campaign: Understanding Historical and Modern Trends 
When: Thursday, November 1, 2018 - Saturday, November 3, 2018
Where: The Marriott Hotel, Marina del Rey, CA

General Registration is now open - July 1-August 31
Pricing: NAHAC Full Members Only:  $399
(includes Full, For Profit and Not-For-Profit Memberships)
General Public/Non-Member Registration:  $435
​For more information: 
http://nahac.memberlodge.com/2018-NAHAC-Conference-Daily-Schedule

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The "Reinvention" of Primary Care Delivery

5/25/2018

 
Happy almost summer! Being a sun worshipper, I am always energized by the longer days and sunnier weather, although in Seattle we are definitely not done with rain just yet.

This month I wanted to share some thoughts I had after reading an excellent article in the New York Times Magazine about the “reinvention” of primary care delivery. It features the work of Dr. David Meltzer from the University of Chicago, who was a speaker at one of the national conferences of the National Association of Healthcare Advocacy Consultants (NAHAC), my professional organization as an advocate.

His research looked at the doctor-patient relationship, and whether longer appointments with a person’s primary care doctor (yes, all of them with the same doctor!) were economically sustainable.

Trying to Put a Value on the Doctor-Patient Relationship
by Kim Tingley

From the article :

“Meltzer insists that doctors spending more time with their patients actually saves money. After a year in his clinic, for instance, patients have 20 percent fewer hospitalizations than their control-group counterparts. Because hospitalizations make up the greatest portion of these patients’ annual cost to Medicare, which averages $50,000 to $75,000 each, that reduction is worth several thousand dollars per person in the first year, or a combined several million dollars; by comparison, the doctors’ annual salaries add up to less than $1 million.”

Dr. Meltzer’s clinics run “leaner”—fewer people in the mix, and:

“To accomplish this feat, he employs the oldest, slowest, least-innovative health care delivery model imaginable: general practitioners who oversee almost all aspects of their patients’ care and, in doing so, come to know them personally.”

What I love about this article (besides the fact that it validates what I have been saying for years) is that it shows that this essential factor in healthcare actually makes a difference, and not just emotionally, which I think most of us believe. It makes a difference economically also, and it made a difference in the health of the patients.

It’s a win-win-win. Yes, I believe technology can help with communication and efficiency, and definitely with access to knowledge. And yes, the huge amount of medical knowledge requires subspecialization since no one can master all the information available in a single specialty. But there needs to be a quarterback that knows the patient and sees them as a whole. This is what I do as an advocate, but I believe that ideally the primary care doctor would fulfill that role and I would no longer be needed!

Now, how do we get the medical industrial complex to listen?

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    Dr. Sima Kahn muses on being a healthcare advocate, the troubles with our healthcare system, and how to advocate for ourselves. 

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