My Secret Addiction

I’m embarrassed to admit it, but I think I suffer from an addiction. It probably isn’t healthy, and it makes me question my view of reality at times, but still, I cannot stop myself from watching medical TV shows. As a healthcare consumer advocate I am drawn to the show Chicago Med. It offers a view into places where human experience, with all it’s power, uncertainty, emotion, and messiness, is portrayed in Technicolor detail along with bloody surgical procedures. That show really gets my adrenalin pumping! Sometimes the scenarios posed in the show leave me replaying scenes in my head for days. You see, television is a powerful medium that exerts a huge amount of influence. It offers a vision of the world and then leaves us to decide whether the vision is accurate or not. It makes us ask the question, “Is this really who we are, what we do, and what we believe?”

A recent episode of Chicago Med has me pondering some deep questions about the current state of medical care decision-making.

In the show an alcoholic was brought into the emergency room with a broken leg. He was a “frequent flyer;” a regular visitor to the ER, and so one of the nurses was familiar with him as a patient and knew he was an alcoholic. The man began to experience delirium tremens, a painful and potentially deadly symptom of alcohol withdrawal. The man stated clearly that he did not want to stop drinking, and he was not going to take any steps to kick his addiction. He was brought in for an injury, not for getting clean. The patient was having seizures, hallucinations, vomiting, and suffering internal bleeding because of the DTs. All he wanted was a drink, yet the doctor on his case refused to allow him to have one, because the doctor believed that getting the patient sober was what the patient needed. The nurse tried to sneak in a bottle of liquor, but the doctor stopped her and told her, “I’m the doctor. I know what’s right for the patient.”

Who gets to make the final decisions about what the patient “needs?” – the doctor or the patient? What values are wrapped up in the decision-making? This was a juicy scenario to consider for a number of reasons.

First, it raises the question of the ethics of treating a body part or treating the whole patient. Should the doctor have just stabilized the patient enough to treat the broken leg, and not concerned himself with the alcoholism? Does the patient’s assertion that he wants his leg fixed but doesn’t want to be treated for alcohol addiction carry any weight? Does stepping over the threshold of the hospital doors mean the patient must follow hospital protocol, give up his autonomy, and give up his rights to make decisions about his body and the course of his medical care? Medical ethicists and human rights advocates argue that the patient retains those rights, and that doctors are supposed to respect them, even if the patient may suffer or even die as a result of those decisions. In this light, treating only the broken leg and not the alcoholism would have been the appropriate thing to do. It’s understandable the doctor may feel that because he has the training and the resources to treat the whole patient, he should treat the whole patient, but only if the patient consents.

Second, it raises the question of which drugs are acceptable, under which circumstances, and why. The doctor treated the patient with benzodiazepines and with Haldol, which are both prescription medications. He refused to allow the patient to have a medicinal dose of alcohol, even though it’s a substance that anyone over the age of 21 can legally consume without a prescription. Why are the prescription drugs acceptable while the over-the-counter one is not?

Third, how do we judge another person’s capacity to make medical decisions when that person appears to be flawed? In this case, the perceived moral failing of being an alcoholic influenced the doctor’s belief in the patient’s ability to make good life choices. The doctor asserted that his medical authority also gave him the moral authority to override the patient’s authority to make medical decisions for himself.

Lest you be tempted to say, “Michal, it’s just a TV show,” realize that these questions play out in real life every day. As the concept of patient-centered care plays a bigger part in how healthcare is delivered, questions like these, which expose the tensions between patients’ rights and doctors’ responsibilities, cause judgment calls to be made in almost every medical interaction.

Doctors and patients may disagree about what the patient needs to stay healthy or get well. They may have different approaches to health, illness, and questions about quality of life. That’s why things like Do Not Resuscitate orders and living wills came about – so that mechanisms would be in place for patients to express their wishes about how to be treated in circumstances in which they could not speak for themselves. When we are patients, we are dependent upon medical caregivers for their expertise, but we are not required to completely submit to their medical authority. We still retain rights that must be respected. Doctors are human beings who are tasked with using their knowledge and skill to improve the lives of others. Sometimes they use their abilities wisely, and sometimes they make the wrong the choices. There will always be a dance between doctors and patients, and we all need to learn our steps so we don’t trip over each other’s feet.

As a society we make fairly arbitrary rules about things like drug use. The perception is that prescription drugs are safe because doctors prescribe them, yet the over-prescription of narcotics is one of the main causes of epidemic heroin use across the country. Patients become addicted to prescription pain medications, and then switch to using heroin because it is cheaper. And prescription drugs may not be the most appropriate remedy. An over-the-counter product or natural remedy may suffice, but those are unlikely to be used in a hospital setting. When I was in the hospital after giving birth to one of my children, I was told I was not allowed to take the ibuprofen (ADVIL) I had brought from home. There were two main reasons why. First, any medication taken by the patient needs to be noted in the patient’s chart, in case of side effects and to make sure no drug interactions will occur. This is for patient safety. Second, the hospital can charge a premium price for the medications it distributes. They often charge up to $15 for a tablet of Tylenol, which otherwise would cost around 11¢. I was scolded for being a noncompliant patient each time I told the nurse I took the ibuprofen anyway, against their medical advice, so they could mark it in my chart.

Coercive care is a common problem for anyone who is deemed “less worthy.” At a conference I attended recently I heard story after story of patients who were told by medical caregivers something was being done “for their own good,” because they were overweight, a person of color, young, female, transgender, or different from what the mainstream consider to be normal. This is what the Chicago Med episode highlighted; that mainstream medicine does not equal moral authority.

As the practice of medicine continues to change, as it has drastically over the previous few decades, we are challenged with examining the changing nature of the authority and responsibility of both patients and doctors. We need to be mindful of patients’ rights and also be clear about our expectations of doctors and medical care. We need to recognize our biases and morals, and see clearly how they intersect in medical situations.

Watching healthcare scenarios on medical shows like Chicago Med reflects choices back to us and inspires us to compare our beliefs to what we see on TV. Rather than viewing it as straight entertainment, I use the show as a catalyst to examine my own beliefs and to learn more about how these scenarios unfold in real life, for real people. Does that make my compulsion to watch the show an addiction, or a healthy desire? I guess that depends on what the people in the mainstream think.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Wash Your Hands Please!

By Michal Klau-Stevens


Would you have the nerve to tell your doctor to wash his or her hands?

We all know that germs travel from one surface to another, often carried by human hands. For people with healthy immune systems, contact with many types of common germs does not always lead to illness; in fact, it’s often not a problem. For people with compromised immune systems though, contact with common germs can lead to illness. Even worse, in a medical setting such as a hospital or surgical center, the types of germs that can be transferred from patient to patient can cause serious illness, and even death. We expect doctors, nurses, and other healthcare workers to be conscientious about washing their hands, but you might be surprised to hear that in some hospitals the hand washing rate of caregivers can be 50% or lower. What can you, as a patient, do to reduce the risk of having germs transferred to you?

During the mid-1800’s a doctor named Ignaz Semmelweis discovered that when doctors in his Austrian maternity hospital washed their hands after doing autopsies before examining women in labor, fewer women and babies died from childbed fever. He implemented a hand washing protocol on the labor ward, and demanded that all the doctors and nurses wash their hands in a caustic solution when they arrived on the ward and before they touched any patients. Death rates from puerperal fever plummeted in his hospital, and thousands of women and babies survived their hospital confinements because of the hygiene measures in his institution.  This took place in the very early days of microscope development, and before germs were viewed by human eyes. Sadly, because Semmelwies was never able to isolate the cause of transfer of illness between people, the other doctors of the time refused to believe him when he said their unwashed hands could be the cause of people dying. He was reviled by the medical community and died an unhappy death in an insane asylum.

Decades later, after microscopy was more advanced, germs were discovered and germ theory was created. Doctors finally understood that indeed, their unwashed hands were the travel mechanism for microscopic organisms that transferred illness from patient to patient.

These discoveries happened in the late 1800’s, so we’ve had well over 100 years to make hand washing the norm in our healthcare institutions and as part of medical training. Yet, a recent study showed that while some hospitals have excellent hygiene practices and compliance, others have compliance below 47.5%. According to the World Health Organization, caregivers are supposed to wash their hands:

• Before touching a patient,
• Before performing a clean/aseptic procedure
• After body fluid exposure risk
• After touching a patient
• After touching patient surroundings

There are a number of reasons why caregivers might not wash their hands, including lack of understanding about the importance of hand washing, a hospital culture that places it at a low priority, lack of time from being overloaded with patients, too few hand washing or hand hygiene stations, and skin irritation from frequent washing.

Even though caregivers know that washing their hands is an effective way of limiting the spread of infectious diseases, it’s not always top-of-mind for them. Since they can’t see the germs, it can be difficult, if not impossible, to connect an illness with a handshake that occurred days before. The importance of hand hygiene can fall by the wayside if the administration and peers within the workplace do not strictly maintain it.

You, as a patient, are the person who will be most seriously affected if hand hygiene is not practiced in the healthcare facility where you’re receiving care. You are the one who will become sick. Therefore, it’s to your benefit to make sure that no one touches you before they wash their hands. Take a few minutes before checking in to familiarize yourself with hand hygiene protocols, so you’ll know when and how it should be done, and when it’s appropriate to be touched with gloves and without. When someone enters your room, watch to see that they take the time for hand hygiene before making skin-to-skin contact with you. If they don’t – ask him or her to do it.

Some people feel uncomfortable taking that stance and making a demand of their doctor or nurse, but it’s your right as a patient to do so. Don’t let embarrassment, discomfort, or over-politeness stand in the way of your health. With the super-bugs floating around in hospitals these days, it’s too big a risk to take. Just a little soap and water or some hand sanitizer could prevent serious illness or even save your life! Be an empowered patient and demand good hand hygiene, because there may be a 50% chance that your caregiver isn’t taking care of that for you.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

The Changing Relationship Between Doctors and Patients

The Changing Relationship Between Doctors and Patients

By Michal Klau-Stevens

“What does the doctor say?”

That’s the question we often ask when a loved one has a health concern. We place great trust in doctors, because of their training and expertise. Yet, the doctor-patient relationship has changed over the past few decades in ways that have a direct effect on your care. Here are some things about the doctor-patient relationship that are different from how they were, even twenty years ago.

It used to be that you had a family doctor or internist who saw your care through from beginning to end. Today, there are many large medical practices, and while you may see “your” doctor for much of your care, it’s also likely that you will see other doctors in the practice, or get referred to a specialist. Medical care has become more compartmentalized, and specialists focus on certain body systems or illnesses. You may need to coordinate your own care while managing orders from several different doctors who may not see the overall health picture. If you need surgical or hospital-based care, you must be prepared to work with care providers who are strangers to you, and who don’t know your individual needs.

Also, the average medical appointment today is 7 to 15 minutes in length, where previously appointments were over 30 minutes. The teaching, conversation, and relationship building that used to happen in the exam room do not happen with the same depth as they used to. The interactions between doctors and patients today leave little time for developing a true relationship in which your physical, mental, and emotional needs are understood as deeply as they were in the past. The discussion time, and therefore the opportunity to develop personal connection, simply doesn’t exist today.

Another aspect of the doctor-patient relationship that is different from previous generations is the access to “special” information. It used to be that doctors’ training taught them information that was not available to patients, which made them authorities whose word was not to be questioned. Today, patients have access to vast amounts of medical information through the Internet, and can access far more data than was ever possible in the past. While most patients don’t achieve the level of medical learning that doctors have, they are able to engage in conversation about their care on a much higher level now than before. This patient access to specialized medical information changes the relationship from one of authority to one of partnership.

In addition to Western, or allopathic, medical information, patients also have access to information about a wide variety of natural, herbal, Eastern, and alternative healing modalities. Most doctors who are trained in the United States are not trained in these other types of care. Many doctors are skeptical about them because they differ so greatly from their “traditional” medical training and some modalities have little peer-reviewed scientific research to support their claims, even though they have been used in other parts of the world for hundreds of years. Patients who wish to use alternative therapies may find their doctor does not support their use, and conflicts will arise.

Medical schools don’t offer a lot of training for doctors on how to manage their relationships with their patients, and the landscape is changing faster than school programs can catch up with anyway. Patients vary in their knowledge levels, and the quality of information they are learning ranges from top-notch science to quackery, depending on its source. Since this shift is still happening, with some patients taking an active role in their care, and others still relying on doctors to take the lead, it’s not always clear to doctors or patients how to manage the changing relationship expectations.

Put together, these changes to the doctor-patient relationship have deeply affected levels of trust on both sides. When patients feel they can’t trust their doctors because they haven’t developed strong relationships with them, they may not feel secure in following their advice, which can cause serious problems. When doctors feel they haven’t developed a strong relationship with their patients, they can’t care for them as well and may be more likely to practice defensive medicine.

What does all this mean for you as a patient today?

This means the demands on you to advocate for your needs are stronger, because you may not be able to rely on a relationship with a trusted caregiver to guide your care. You must be more outspoken about what you need and want throughout your care, and you must develop skills to help you communicate effectively with unfamiliar caregivers.

In order to do that, you must be proactive in learning about your health needs or illnesses from trustworthy outside sources. You can’t assume your doctor will tell you everything you need to know because there is not enough time in typical medical appointments to give you all the information you will need to make truly informed choices.

Be prepared for your appointments by doing research in advance, and having a list of questions prepared with the most important questions at the top of your list.

Finally, you must seek out doctors and medical practices that match your care philosophy and approach to medical care from the outset. Each practice has its own work and medical care culture, and it’s up to you to explore all the options available to find which will be the best fit.

As frustrating as it can be to both patients and their doctors, the days of “just do as your doctor says” and “letting them take care of you in the hospital” are over. The changing doctor-patient relationship makes getting good individualized healthcare different now than it used to be. The times, they are a’changin’.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!