Planning Ahead: Durable Medical Power of Attorney

As you learn about making your way through the healthcare system, there are many things to think about. An important tool is the Durable Medical Power of Attorney.

A Durable Medical Power of Attorney helps to assure that the medical professionals and your family/friends are able to carry out your wishes if you are unable to communicate due to illness or injury.

A Durable Medical Power of Attorney is a document that you create. It grants the authority to a person of your choice to make medical decisions on your behalf if you are unable to participate in the care planning.

Durable Medical Power of Attorney is also known as Advanced Directives.

A Living Will provides instructions to doctors, hospitals and family/friends concerning the use of specific procedures designed to sustain life – such as ventilators, feeding tubes, or dialysis. A living will also authorizes medical facilities to withhold certain procedures if there is no reasonable chance for recovery. This document outlines YOUR wishes – there is no need to appoint anyone to carry them out.

You may have both a living will and a Durable Medical Power of Attorney.

To create a Durable Medical Power of Attorney, check the laws of your state. Often the forms are available at no charge online or at your healthcare provider’s office.

With a Durable Medical Power of Attorney, you are not giving up control; rather you are making sure that your wishes will be carried out if you are unable to make the decisions.

The person you choose does not have to be a family member, nor does it have to be the family member that lives closest. It should be someone who is readily available by phone in case of emergency. Select someone who knows you and is willing to carry out your wishes about your medical care.

Copies of your Durable Medial Power of Attorney should be given to your physician, your hospital, the person(s) you have chosen to represent you, and extra copies in a safe place such as a safety deposit box or a fire-proof cabinet. Make sure your emergency contact and at least one other person knows where you keep it and how to access it.

Often, we find it too difficult to think about these issues – we still have YEARS of a good life. But, if we don’t plan for the unforeseen, we could end up in a situation where our wishes are not taken into consideration. It is important to plan ahead, and to talk to those who will be making decisions on our behalf about what we consider to be quality of life. These conversations are much easier in theory than they are in reality, so plan ahead. Make your wishes known, and choose who will make those decisions if you can’t.

 

How to be a Good Healthcare Consumer

For the newly insured, there can be a learning curve about how to appropriately use healthcare services. Some of us who have had insurance for years could also use a refresher!

Once a person is insured, it is time to make an appointment with a healthcare provider. There are several options for care. Most insurers refer to a “Primary Care Provider” which is a healthcare provider who is chosen by or assigned to a patient and both provides primary care and acts as a gatekeeper to control access to other medical services.

The primary care provider can be a physician, either a DO or MD, but it may also be a Nurse Practitioner or a Physician Assistant.

There are actually two ways to achieve the title of doctor and practice medicine. One can become a medical doctor (MD) or a doctor of osteopathy (DO). Both licenses allow one to practice medicine and have equally rigorous testing.

Nurse Practitioners are registered nurses trained to be a primary healthcare provider. Their education is based on nursing model and philosophy. Master's degree with relevant experience + Certification + License to practice.

Physician Assistants are healthcare providers practicing medicine under the supervision of a physician. Their education is based on medical model. PA program + License to Practice.

Once you have an appointment with the Primary Care Provider you have chosen, it is time to focus on your appointment. First and foremost, this means turning your cell phone off. Paying attention to the visit with your primary care provider is important.

When you go to your appointment, make sure you have the following information:

·         Insurance card(s)

·         Driver’s license or other proof of identity

·         Any forms the office has sent you to fill out – and have them filled out

·         Health history for you and your family (any chronic diseases your parents, siblings, grandparents have or had)

·         A list of all medications you are taking – prescription and over-the-counter, including vitamins and supplements

·         A list of all allergies

It is important to be prepared to discuss your health with your primary care provider. You will have a limited amount of time for the appointment, and you want to leave with the information you need. Often it is helpful to bring a family member or friend along to be an extra set of ears.

Some tips for talking with your primary care provider:

·         Always remember that it is your body

·         Share your concerns and medical history quickly and accurately

·         Ask questions

·         Take paper and pencil to write down notes during the conversation

·         Make sure you understand any instructions that are given to you

·         If tests, procedures or new medications are suggested, ask some additional questions

o   Do I really NEED this test, procedure, medication?

o   What are the benefits and downsides?

o   Is there a simpler, safer option?

o   What happens if I do nothing?

o   How much will it cost?

Good healthcare is a cooperative effort between you and your healthcare provider. The best healthcare also involves family/friends/caregivers.

 

 

Healthcare: It's Personal

In the past 12 weeks, at one time or another, my dad, my husband, my aunt and my mom have been in the hospital. It has included 4 emergency room trips, 2 ambulance rides, 3 hospitals and countless hours.

This is my rant, my request for prayers, and my reminder to be grateful.

It is always frightening, anxiety-producing, and overwhelming to have someone you love in a life-threatening situation. Trust me – being a nurse does not make that any easier. I know enough to be terrified, but not enough to be helpful in most situations. I typically do not tell the healthcare professionals that I am a nurse – until either it is in the best interest of my loved ones, or if I am being treated patronizingly, then I will tell them.

My dad has been the most frequent inpatient – surgery, complications, a fall, more complications and a stay in rehab to regain strength from all the hospitalizations! He is 83, and as amazing as he has always been. His strength and determination are an inspiration to me – always, but especially now.

My husband ended up in the hospital for the third time in a year. “Ugh,” is all I can say. We are too young to be going through the things he has endured for the past year. I always hope that his health will stabilize, but there are no guarantees. New treatment options are in the very near future - exciting, and scary!

In the midst of my dad’s stint in rehab, my mother calls to tell me she has called the ambulance – she is having chest pains. I have to admit, I figured it was anxiety and stress. She has been through so much lately. But, I was wrong. She had a heart attack – the “widow maker” – her LAD nearly totally occluded. She was lucky – one stent – and she is feeling pretty good. Obviously, she started off exhausted, so it will take some time for her to recover. But, I am amazed at what can be done with minimal invasion and a short recovery time.

I have seen excellent care; I have seen awful care, and individuals I wanted to choke. As in any profession there are good people and there are those who just want to get by; those who are doing work that is meaningful and fulfilling to them, and those who just want a paycheck. It is too bad that people ended up doing work that they don’t like. It usually shows.

Our healthcare system is broken in so many ways – I have given the same information to a dozen people. The need for universal electronic medical records is one thing that jumps out for me – the emergency room and the cardiac care unit can’t even communicate with each other, so too much time is wasted asking the same questions again and again. Medications are changed due to the formulary each institution carries; referrals are not made; communication between the hospital and the primary care provider is incomplete; and, too often, there is not enough staff and response time can be long. It is frustrating and scary.

I don’t have any magic idea to fix things. But, I have a new appreciation of how hard it is to be the family of someone who is hospitalized. Some things would be easy to address: tell the family where they can get water, food, a restroom, and answers. Look at people when you talk to them – not at the computer or the paper in your hand. Answer questions in a manner that is understandable. Tell us the options – not just what you want us to do.

I also have a new appreciation for my family. Growing older is a bitch. It is not easy, it is not without issues and it is not the “golden years.” It is hard. I cannot imagine how people do it by themselves. I am exhausted and overwhelmed – and I have a brother, a sister, a husband, a son, a daughter who are all involved in the care of the various family members. I have the support of family and friends, and I am still overwhelmed and exhausted.

My cousin is dealing with the parallel issues with her parents; I can’t imagine how I could do this without her support, encouragement and presence in my life. We walk, whine, drink wine, laugh, talk and support one another on this journey.

So, this is my opportunity to say thank you to all the family and friends who have made this part of my journey easier – the kind words, the prayers, the time listening to my story, the glasses of wine and all the help. Thank you. I am so grateful to each and every one of you.

What has changed?

That was the question posed to Keith and me by a college student working in the pharmacy with us last week. What has changed since I started in nursing? Since Keith started as a pharmacist?

Wow – what a great question. Keith and I both started down memory lane. I remember mixing chemo on the unit – no gloves, no gown, and no ventilation hood. No gloves ever – for anything. I have never started an IV wearing gloves – that era began after HIV/AIDS. I remember seeing the first AIDS patient on our unit the same week that Newsweek came out with a cover story naming AIDS for the first time.

No DRG’s (Diagnosis Related Groups) – hospital stays were often weeks, if not months, for those newly diagnosed with leukemia. Antibiotics have improved; chemo has improved – the side effects can be so much better managed with medications today.

We talked about all the medications that were not available when Keith and I started. It was interesting to talk about – so many changes happen so gradually that you soon forget it hasn’t always been that way.

I guess that is true of most things in life.

I’m glad she asked the question – I will continue to think about the answer.

Betty

Tuesday afternoon, I was sitting in my office when the phone rang. It was one of my former patients from the Diabetic Clinic.

She had been a patient here for at least 5 years – besides diabetes, she had an ovarian mass that we had been watching closely.

She and her husband both work; she works at a nursing home. Neither of their jobs offered insurance. Her husband suffered a heart attack last year, so they are paying hospital bills for that. She came in to see me in November to look at healthcare through the Marketplace. She picked a plan that fit into their budget with low monthly premiums, but a higher deductible. She was thrilled to have insurance that would start January 1, 2014.

So, when she called – my first thought was that she had found the high deductible to be more than they could afford. But, no – what she called to tell me was that she had been diagnosed with cancer. I assumed it was the ovarian mass, but was wrong again. She has been diagnosed with cancer of the esophagus, liver and lung. She is 55 years old.

I felt physically sick.

Glad that she has access to care; glad that she wanted me to know; a stark reminder that none of us knows what tomorrow brings.

Please keep her in your prayers.

Keith

I first introduced Keith on January 15, 2013 as one of my heroes.

Last week I worked in the pharmacy with him for the whole evening. One thing that never changes about Keith is that he loves to talk. So, while we worked, we talked.

When I last wrote about him, he had been diagnosed with Stage IV prostate cancer with bone metastasis. The prognosis at the time of diagnosis was 3 months with conventional therapy. Well, there is nothing conventional about Keith – so he chose experimental therapy.

September will be 3 years since he was diagnosed. It has been a tough journey for Keith and his family, but through it all, he has continued to work at his “real” job AND has continued to volunteer regularly at the clinic.

I am awed and amazed at that. There have been times when he was so exhausted he could hardly stand up; the only times he has missed his scheduled work days here are when he has an appointment at the University of Michigan on a Tuesday. Otherwise, he comes here.

He has always been one of my heroes, and during this time he has taught me – and others – about living, about faith, and about hope.

The Final Diabetic Clinic

“Sad.” “Relieved.” “Grateful.”

“It’s like a divorce you knew was coming, but didn’t want.”

Those were the words I heard from the patients in the Diabetic Clinic as we had our last-ever meeting. It was the last one because they all qualify for healthcare insurance. Two purchased healthcare insurance through the Marketplace; one qualifies for Medicare this month; the others all qualify for the Healthy Michigan Plan – Michigan’s Medicaid expansion program.

It was a bittersweet evening. We have been doing the Diabetic Clinic for around 10 years. It was the vision of Andi Scholl, PA-C. He wanted to try something different and new for diabetics – a clinic devoted to them done in a group setting. The patients all came in at 5 p.m. They had their vital signs (blood pressure, pulse and respirations) done, as well as their weight. Each one would talk to one of the nurses about what they needed that night – medication refills, to see the provider, test strips, etc. Then the group would meet together to share an educational program and a healthy snack.

When the provider came in, the ones that needed to be seen would have a chance to be seen individually. Each patient received a month’s worth of medications and glucose test strips to go with the meter the clinic provided.

The clinic was created by an amazing group of volunteers in addition to Andi. There was Pat Morgan, RN, and Sean Codier, a student at Hillsdale College who is now an MD with the U.S. Army and stationed in Korea.

Over the years, many others have volunteered their time and talents: Natalie Wyma, PA-C; Dr. Steigerwald; Dr. Schall; Linda Cosier, LPN; Marilyn Williams-Bayer, RN; Char Byers, RN; Mary Skupinski, RN; and, Cindy Horwath, RN. The pharmacist for the Diabetic Clinic has been Tim Skupinski, RPh.

I have some mixed feelings as this program comes to an end. It has been an amazing group of professionals to work with. The group of patients, for the most part, have been motivated, compliant and eager to take control of their lives. They have come each month to take part in the group. The names and faces have changed frequently over the years, but the support and care they gave one another stayed the same.

We will miss seeing them and they will, at least initially, miss seeing us. But, they are so much better off insured. They are a success story today – thanks to the Affordable Care Act.