Some Days Count More Than Others

Which is more important – the day you receive a diagnosis or the days of treatment that follow? The surgery or the recovery? Does a short-lived healthcare incident matter more or less than the many days that follow it?

A comment I’ve heard many times over the years as a consumer advocate for pregnant women is, “Why do people spend so much time worrying about the day of the birth, but they don’t invest the same energy into learning how to parent after the child is born?” While I understand the thought process at play, I disagree with the implication that the birth, which is only one day, is less important than the ongoing tasks of raising a child.  Similarly, the treatment of an illness can be a lengthy process, while the diagnosis stands out as a pronouncement, and the recovery from surgery happens over weeks and months, while the surgery itself only takes a few hours. Yet the diagnosis, the surgery, and the birth, while shorter in duration, lay the foundation for what follows. They act as ‘pivot points,’ which affect the way everything that follows unfolds. Because of this, it is worth investing the time and energy to make sure you are preparing for those important moments properly.

People make the mistake of believing that healthcare providers all practice the same way, hospitals all provide services equally, that care providers will tell them everything they need to know, and that our advanced healthcare system almost guarantees a good outcome. But evidence shows that there are big differences in quality of care between providers and facilities, and patients have to be proactive in learning about their healthcare needs and advocating for themselves. Just trusting “the experts” without checking to make sure that trust is warranted for your case can lead to serious and lengthy consequences.

If you aren’t seeing a truly skilled doctor or getting the right diagnostic tests, the diagnosis may be incorrect and all the treatment that follows will be less effective or not effective at all. A surgery that is botched can make recovery longer, more painful, or even cause greater damage than it was meant to correct. People clearly remember the birth of a child for their whole life, including how they were treated, what was said to them while they were in labor, and whether they felt fear or joy. Those memories form the basis for their feelings towards their baby and their sense of competence and as they do all those feedings and diaper changings for their newborn. Clearly, getting things right from the very start of a healthcare journey has an effect on how rocky or smooth the road is and where the journey ends up.

The secret to an easier journey is in the preparation. Those ‘pivot points;’ those days that stand out because they set a new life course, rarely stand alone. Instead they are the result of the work you did, or didn’t do, to get you to that point in the journey. So is it worth it to get that second or third opinion on a diagnosis? Is it worth it to interview surgeons and find healthcare centers of excellence for surgeries and procedures? Is it worth the time and energy to prepare for birth?

Absolutely.

What happens in the long-term needs planning and attention too. Having knowledge, making informed decisions, and being prepared for the treatment process, the post-surgical recovery, or parenting shouldn’t be ignored. It’s all important. Don’t make the mistake, though, of downplaying the ‘pivot point’ because it’s only one day. Some days count more than others.

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!

$16M Jury Award is a Victory for Healthcare Consumers

Truth in advertising matters in healthcare. An Alabama hospital recently got that message loud and clear with a $16 million jury award against it. The verdict in the Malatesta vs. Brookwood Medical Center court case also sends a message to healthcare consumers that they have a powerful tool for holding facilities and providers accountable for the promises they advertise.

Caroline Malatesta was swayed, in 2012, by an enticing advertising campaign to switch hospitals for the birth of her fourth child, from one that offered a restrictive model of maternity care to one that claimed to offer autonomy and personalized birthing options. The care that she received during the birth, however, was more restrictive and medicalized than her previous birthplace, and resulted in a permanent injury. She took the hospital to court for fraud and on August 5, 2016, a jury awarded her and her husband $16M. That sum includes punitive damages in the amount of $5M, which were awarded for reckless fraud directly relating to the advertising campaign which promised more natural birthing options.

According to a blog post on the Malatesta’s law firm’s website, the Brookwood Medical Center ads emphasized a mother's choice, individual birthing plans, freedom of movement and even mentioned water births. Yet, when Caroline was in labor there she was not allowed freedom of movement or access to a birthing tub, and she was forcibly restrained by nurses, who held her baby inside her for six minutes until a doctor arrived, causing a type of permanent nerve damage. Reports state that water births had been banned internally in the facility since 2013, yet advertisements still included it as an offering at the time Malatesta filed her suit, nurses had not received special training in managing natural births, and the depositions show that there was not a system in place to alert staff that a patient was planning a natural birth. A nurse reported that the messages about natural birth in the advertisements were not communicated to the staff.

In interviews Malatesta has said that she tried to talk with the hospital administration to get answers about what happened to her, but they were not responsive. "Unfortunately I felt like I didn't get any real answers. And they eventually just shut me out. That was when I realized the only option was litigation," stated Malatesta in one of her interviews posted online. One of the claims the lawsuit alleges is that Brookwood “[marketed] natural birth services without sufficient coordination to ensure that the medical staff and other caregivers were aware of, trained in and committed to providing the services advertised.”

Malatesta reluctantly pursued litigation, but she did so because her injury was so debilitating and expensive. Once the media picked up her story, she heard from other women who had also been duped by Brookwood’s advertising campaign and received poor quality care there. In one article she says, "It's meaningful to me that so many women have contacted me and told me that the verdict was their validation that they never got. That gives meaning to an injury that's hard to come to terms with – a bigger meaning than myself."

In addition to Malatesta and the numerous other women who were drawn in by Brookwood’s false advertising and now feel that justice has been served, other healthcare consumers may benefit from this verdict. As healthcare consumers become better informed about their options, competitive hospital markets may be tempted to use “buzzwords” that appeal to savvy consumers without backing up their claims. Competition between hospitals can be intense in many communities, and marketers may be tempted to tap into the latest healthcare technology and trends being hyped in the media without the staff or facility being able to support that type of care. But, large jury awards like this one put the healthcare industry on notice that they must provide what they promise, or risk being held accountable. Also, cases such as this one set legal precedent, paving the way for other similar cases. The fact is, the legal system is one of the few ways that individuals can sway the actions of large corporations for enforcement of laws and standards of care.

While all healthcare consumers won’t get a piece of the monetary award in this case, they will benefit from the awareness that is raised when a large sum is awarded in a legal case, and they will benefit from the precedent that’s been set for truth in advertising about healthcare services. For those who have suffered injury as a result of the medical decisions they made based on the promises of a healthcare facility that didn’t live up to its promises, this case can serve as a reminder that the legal system can help individuals in getting justice in when dealing with giant corporations. 

 

 Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a 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!

Five Steps to Better Healthcare

Do you know how to get the best healthcare to meet your family’s needs? As the healthcare system gets more complicated, appointments with your doctor get shorter, and costs continue to rise, getting individualized, evidence-based care is a challenge. Personal healthcare advocacy skills are techniques to get information and take action so you can make standardized care a better fit for your and your family. They include understanding some basics about how the modern healthcare system works, knowing what actions you can take to increase your chances of getting the care that’s best for you, knowing what questions to ask and how to make informed decisions, and knowing your rights as a patient. With some personal advocacy skills under your belt, you can learn get the most out your healthcare. Here are five things you can do that can help you get better care.

1. Understand the business of healthcare
Healthcare in America is a business. There is a strong incentive for profit. You need to understand how doctors and facilities make money and get paid, or you may end up paying for tests and procedures that aren’t medically necessary. You need to be an informed consumer, like you’d be if you were buying any other big-ticket consumer item.

2. Get clear on your values, needs, and desires
You are the expert on you. Your input is important, so you need to be clear on how much control you want over decision-making, what your care philosophy is, what your medical, physical, emotional, and practical needs are, and what you want and expect while being a patient. Even great doctors need your input. They can’t know everything about you, so it’s up to you to convey your thoughts and opinions throughout the care process. Communicating your values, needs, and desires is the key to getting individualized care.

3. Meet your community
Connect with people who can guide you to great doctors and facilities. Ask around, get referrals, and interview providers. Tour facilities. Learn about all the different types of care that might be available in your community. Connect with others who have similar health issues, and use their knowledge to expand your own. There’s no need to reinvent the wheel, when there is so much crowdsourced knowledge so close at hand. Create systems of support so you’re not going through your health needs alone. Supportive communities can literally be life savers.

4. Build a strong team
Find providers who match your philosophy of care, so you’ll be more likely to have a good working relationship. Work with providers who go the extra mile to spend the time you need to understand your health situation and make sure you’re actually being cared for. If you keep getting a nagging feeling that it’s not a good fit between you and your provider, switch. Your health is too important to leave in the hands of someone who is hard to work with, or you don’t trust.

5. Have effective conversations with your care providers
Do research on your condition, so you understand the basics and can talk about it quickly and efficiently with your doctor. Ask BRAIN questions (watch this video to know what those question are), and speak up for yourself. You won’t get the things you need if you don’t ask for them, and doctors and other caregivers can’t read your mind. You need to speak up about your values, needs, desires, thoughts, and opinions to get care that focuses on you.

Do these five things, and you’ll be better prepared, better informed, and ready to take actions to get care that works for you and your family.

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!

When Should You Go to the Emergency Room?

The way we access healthcare has changed quite a bit in the last two decades, and there are new options available for getting medical help when you get injured in an accident or if you become ill. I attended a talk recently by Dr. Michael Gutman, Medical Director of New England Urgent Care, and he shared important information about when to go to the emergency room and when you can seek out alternative urgent care options.

With the growing shortage of primary care physicians, and the available doctors getting busier every day, there’s a good chance that at some point your doctor’s office may tell you to go to the emergency room if they can’t see you right away. Or, you you might have symptoms that are more than what your doctor treats in the office. But, emergency rooms are meant to handle to the most serious health problems. Going there when you are experiencing a problem that is less acute can keep the most critical emergency patients from getting the quick care they need, and can cost you extra time, money, and hassle. 

Walk-in health clinics are popping up all over in communities around the country. Some of them offer a good alternative to going to an emergency room, except for certain very serious or life-threatening cases.

So, when should you go to the emergency room?

Dr. Gutman says you should call 911 when -

• You think you are about to die*
• Your breathing is so impaired you can’t talk in sentences
• You are having chest pain that you think is a heart attack
• You or your spouse think you are having a stroke
• You have altered mental status
• You used to be able to walk yesterday and today you can’t
• You are injured and you can’t walk as a result

*This is not meant as a joke. Dr. Gutman is an experienced emergency physician with military experience in Iraq. He says that people with anxiety can have this feeling and it doesn’t mean death is imminent, but when an injured or ill person expresses they feel they are going to die, it is not a good sign. Get that person to an emergency room right away.

If the symptoms you are experiencing are not mentioned above, you are a good candidate for a walk-in urgent care clinic. An urgent care clinic differs from other walk-in clinics because it can handle more complicated emergency health issues. Where some clinics offer immunizations, strep tests, checking for ear infections, or treatment for cough, cold, flu, or minor injuries, urgent care clinics can do more. They can take x-rays to check for broken bones and do stitches on small lacerations, and may offer other services too. For example, New England Urgent Care does IV fluids, x-rays, and stitches on larger lacerations, because all their caregivers have at least two years of emergency room experience. They have lab facilities and rapid analysis through St. Francis Hospital, if necessary. They also have on-site pharmacies, and they can expedite your admission to the hospital if transfer to a hospital is deemed necessary.

Some of the benefits of going to a clinic rather than an ER are that the copays are usually the same as a doctor’s visit instead of an emergency room visit, the charges are much less, and there’s usually a short wait time before you are seen by a doctor, nurse, or physician’s assistant.

When my husband slipped and fell on the ice last year, he went to New England Urgent Care. He was taken in for x-rays within 20 minutes of our arrival. X-rays confirmed he had broken two ribs. The physician’s assistant gave him clear, written instructions for care. He left with a filled prescription for pain medication and instructions for follow-up. He was home resting in just about an hour and a half. And, we didn’t have a heart attack when we saw the bill. It was a great alternative to a hospital emergency room.

Check to see if there are any walk-in urgent care clinics in your community. Find out what services they offer, and if they would be a good alternative to the emergency room of your local hospital. It’s a good idea to check clinics out in advance, before you have an emergency such as an injury or illness. When that happens, you might not have the luxury of time to do the research.

Be prepared, and know which urgent care clinic or emergency facility is right for you.

New England Urgent Care has clinics in West Hartford, Simsbury, Bristol, and Enfield, Connecticut. Their website is UrgentCareNewEngland.com.

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!