The Importance of Earnest Service

I interrupt my planned post for today to write this morning about a serious state of affairs regarding Corona-19 vaccine distribution: money can put you at the head of the line. I heard about it this morning.

Money impacted Vietnam War deferments. Sons of the wealthy who sought them got them. That was nothing new: deep enough pockets to hire the canniest lawyers have always plucked scoundrels off the hook for crimes committed.

How naive I was to think this wasn’t the case for today’s crisis. Here’s why:

NYC Housing Authority Photo: nyulangone.org

Thousands of New York City Housing Authority development residents have been given the vaccine so for once, while I and my computer-savvy friends are struggling to wangle an appointment online, some with few resources or ability to do this were being served first. I was glad.

I admit that my requirements restrict my chances. I want to walk to my appointment–5 miles my limit–and a trip, alone, to dodgy neighborhoods, as many friends have suggested, is out of the question.

Dr. Arthur Caplan. Photo: twitter

Simultaneously thousands of appointments have been cancelled in NYC this week for lack of vaccine. On his weekly segment on the WOR morning show today Arthur L. Caplan, Professor of Bioethics at New York University Langone Medical Center, reported to hosts Len Berman and Michael Riedel that people were paying to jump the line. I hadn’t heard this before.

What’s worse: There are no punishments to thwart them he said. Dr. Caplan warned Len, who has a vaccine appointment for next week, not to count on it. He cautioned that it might take a month to sort out the clog in the system. The three men shared anecdotes of people–even from Canada–flying to Florida or lying about their ages to be vaccinated.

To make matters worse, the outgoing administration left no plan with which the current one might run to help sort things out at local levels nationwide.

Do you feel all’s fair in an emergency and people with money deserve to go first because they’ve earned the right? Can you think of additional instances where money overrides first come first served?

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Block long line to be tested for Covid-19, 8:30 a.m.

The pandemic is hard on everyone. Here are a few things I noticed about getting things done in the city that impact seniors, those with disabilities and the time-pressed.

It’s ironic because a city like New York allows seniors to be independent with its myriad transportation options, nearby watering holes and entertainment opportunities.

Standing for Service

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I needed a battery for my iPhone. The Apple staff at the store at Grand Central Terminal couldn’t have been nicer. But there was a lot of standing around waiting: to go upstairs after being checked in; on a line upstairs properly socially distanced–and then hanging out in the station for an hour while the phone was fixed. My appointment was in early evening so the few stores that remain in business at the station were shut. There were neither seats nor distractions.

Standing for Testing

We’re encouraged to be tested for Covid-19. The procedure at urgent care locations in Manhattan is daunting I’m told. You must have an appointment and can only sign up for one the same day. At certain hours I pass long lines outdoors, some with people better socially distanced than others, on cold, rainy and mild fall days [photo above].

I wonder, as I head for the gutter to keep more than a 6-foot distance, why are these people in line? Have they been exposed to Covid-19? Are they feeling ill?

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One friend found a place that had no line. She made an appointment and they called her when they had a free time-frame which gave her 30 minutes to get back. Best that you live very near this place and choose a day with no appointments because you don’t know when you’ll get the call.

Goodness only knows what the rollout to get a vaccine will be like.

A benefit of the suburbs is that you can wait for a test in your car.

Pin the Tail on a Bank: Three’s a Charm

I needed to have a document notarized and was told by my bank that every branch had notaries. No longer accurate. I asked a customer service staffer at the first branch to call another one to confirm that they had a notary. Nobody picked up so I walked there. That customer service man disappeared in a back office.

After I waited the length of time in which three people could have had their signatures notarized he returned and told me I needed an appointment for the next day. At least this customer service person knew of a branch that had a few notaries so off I raced.

I appreciated the mileage I’d covered–recorded on my iPhone–but not the stress and I couldn’t help wonder what if I was unable to hotfoot it around town?

Just Sayin’

I love Trader Joe’s but notice that many shelves are empty during early senior hours no doubt because there hasn’t been time, at 8 a.m., to restock them.

Have you noticed other topsy-turvy situations during the pandemic that have impacted the way/how quickly you do business and/or conduct your life? Do you observe situations that especially impact seniors and the time-pressed?

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I ordered something on the Internet and tracked its whereabouts a day after receiving an email stating “your order has shipped.” Someone had printed a label. Would you call that “shipped?”

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I’ve largely represented consumer products, organizations and events in my  career–no politicians or controversial issues. I’ve counseled clients when I thought they might word a description in a different way–a pattern featuring a green leaf is not “unique”–or suggested they drop an unsuitable element from their special event. Sometimes clients agree, sometimes not. I resigned one account run by a person whose inappropriate behavior and demands would have rubbed off on my reputation.

Nobody can counsel the president. I wonder if any try. He discourages me when he raises false hope and makes inaccurate declarations. The headline on Berkeley Lovelace’s article on cnbc.com, “Trump says U.S. may have coronavirus vaccine ‘far in advance’ of end of the year,” quotes the president from his August 3rd news briefing. He didn’t soften it with “I wish,” or “I hope” –which we all do. He declared it.

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We want to believe it. Maybe he knows something we don’t know. But it doesn’t seem that way.

Vaccinologist and physician Gregory Poland, MD, of the Mayo Clinic predicted in an interview on WOR 710 Radio yesterday morning that the soonest we can expect a vaccine approved for emergency use would be early in 2021 though March/April for full use would be more likely. Even then, there wouldn’t be enough vaccine for everybody and essential workers would be inoculated first.

Is false hope a successful strategy if expectations are consistently dashed? Should a leader treat citizens as some adults do children declaring regardless of what it’s about–audience size,  state of the economy, vaccine readiness– “it’s true because I say so”?

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Speed provides many benefits along with some casualties.

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I’m grateful for advancements in medicine starting with glaucoma tests. I was very young when I had the first one when my father was diagnosed with glaucoma. It took forever, was uncomfortable and horrifying. Today’s test [photo right] is over in a flash. Thank goodness for dentists’ high speed drills. In another field, I’m grateful to see  links to articles shortly after they’ve been posted, as a result of pitches I’ve made on behalf of my clients. Thank you Google Alerts.

In “Service of Cooking Under Pressure” I wrote about the Instant Pot that works for many but blows up and intimidates others.

I heard about another casualty of our zoom-zoom expectations on the Len Berman and Michael Riedel morning show when they interviewed legendary golfer Jack Nicklaus earlier this week. Golf is losing players and followers among the young because it takes so long to play or watch on TV: 4 hours vs. 3 hours-and-change for most other sports. Nicklaus admitted that the golf pundits must figure out ways to speed things up.

Speaking of speed, do people still speed read today? It used to be a big thing that never caught on with me.

What do you appreciate that takes less time today than before? Are there some things that should be slow or shouldn’t–or simply can’t–be revved up?

Photo: golfdigest.com

Donna Hammaker, Esq & Dr. Thomas M. Knadig, EdD

Did you know that:

• Congress defines what “equivalent” means when it comes to generic drugs and that the therapeutic effectiveness of a generic might actually be half as that of the brand according to this definition? More below.
• About 1/10^th of the U.S. population has no health insurance; most of them are earning middleclass incomes and the lack of coverage causes two deaths every hour?

I learned this at an eye-opening program of the Healthcare Public Relations and Marketing Society of Greater New York [HPRMS]. Nancie Steinberg, president, introduced the speakers Donna K. Hammaker, Esq. and Dr. Thomas M. Knadig, EdD, who addressed representatives of some of New York City’s most prestigious hospitals and health organizations and the marketers and PR professionals who counsel them.

While some of what I heard was shocking, the takeaway as a consumer was nothing new: When it comes to your health, be informed and ask questions.

About the reference to generic drugs above, Hammaker said you could not pay her to take generic drugs from India or Israel. She mentioned “brand generics” by Novartis and Pfizer that seemed to pass muster.

The speakers, on the faculty of Saint Joseph’s University, Philadelphia, and authors of three textbooks for students and health care managers, the most recent of which is Health Care Management and the Law, shared data-driven facts and statistics gathered in the last two years.

Laced in the discussion were factoids about the Affordable Care Act, such as that much of it was first addressed during the Nixon administration and that many people are unaware of what’s in it. Healthcare has been Hammaker’s professional focus as a lawyer and yet even she was surprised by bits that she learned by studying it. [One wonders how many lawmakers are still in the dark and yet they call for changes.]

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A caveat: I’ve posted sound bytes throughout this post. On just one of these topics alone, Clinical Trials, Hammaker gives a three hour lecture in which she addresses the differences between brand and generic drugs. There is similar backup in her latest 830 page book and hours-long lectures relating to her other contentions and conclusions. For example in Health Care Management and the Law the authors reference court decisions relating to the use of reprocessed medical devices which, in the interest of brevity, I don’t go into here.

Following are just a few highlights based on a list the authors handed out and subsequent discussion.

• “Reprocessed medical devices are a cause for concern, as the FDA standards are not always strictly adhered to, patients are not necessarily informed they are receiving a reprocessed device, and such devices are often obtained from unregulated sources, such as the Internet.” Hammaker recommended that before undergoing a procedure that a patient specify on the hospital consent form that he/she wants a new device as well as the name of the manufacturer of the device. She explained, for example, that some hip replacement devices are made of cheaper metals that tend to break. In addition, she reported, the FDA is lifting restrictions in this area.
• 

  Photo: WebMD.com

  “Over 60 percent of the yearly $1.9 trillion employers spend on health care costs go toward treating tobacco-related illnesses.” We learned that it is legal for an employer to refuse employment to a smoker. In addition, an employer can charge current employees who smoke more for insurance; force them to take smoking cessation classes as a term of employment and conduct random tests [of hair] to identify smokers.

• “Estimates indicate 90 million people in the US live with a preventable chronic disease [such as diabetes and hypertension often caused by such factors as smoking and obesity], the ongoing care for which amounts to 75 percent of the annual $3.3 trillion health care budget.” As health insurers are no longer covering illnesses and disease that could have been prevented, Hammaker asked, “Is this a direction we want to take?”
• “While the biggest burdens to the U.S. health care system are depression and gun violence, they receive scant attention in the health care reform debates; yet the cost of gun violence in the US is equal to the cost of smoking, obesity and other preventable health care illnesses combined. Estimates of civilian gun ownership have been as high as 330 million vs. the U.S. military and law enforcement that possess approximately 4 million guns. The nation’s risk pools absorb $1.4 billion yearly to cover anticipated costs of treating victims of fatal firearm assaults.”

There are a lot of hot topics here and no doubt people who disagree with some conclusions. [We know people who suffer from a disease–chronic Lyme–that many physicians and insurance companies don’t recognize.] Were you surprised by any of this information? Are you more assertive in dealing with your health issues and those of family members today than you were in the past? Are you concerned that information like this is not readily available making it hard to protect yourself appropriately?

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Plastic surgeon Dr. Bahman Guyoron’s patient wasn’t pleased with the job he did on her nose to “alleviate nasal congestion,” according to Wall Street Journal reporter Joe Palazzolo, and while at it, he was to cosmetically tweak her beak. So she shared her thoughts about the outcome on a range of online review sites from RealSelf, Yelp to RateMDs.com, and Dr. Guyoron sued her.

The patient said she now must sleep with a breathing aid because her nostril collapses and that her nose is wider than it was before surgery. A second surgery by the same doctor didn’t fix the problems.

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Her lawyer said “her reviews were ‘substantially true or were her opinion,’” and that they didn’t harm the doctor’s reputation.

Palazzolo explained that the doctor would have to prove they were false and that he was damaged. “If the jury deemed him a public figure, he would have to show that [the patient] knew the information was false or showed reckless disregard for the truth.”

In email correspondence with the newspaper the patient wrote that her purpose was to inform others and that she didn’t expect to face financial ruin as a result. According to lawyers who handle such cases, wrote Palazzolo, “a negative comment can diminish a doctor’s business in short order.” And because doctors’ hands are tied due to privacy laws to discuss details of procedures, to get patients to erase such reviews some opt to sue.

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“‘Given how few defamation cases go to trial—and cases involving doctors are even more rare—any trial would be an important signpost for future litigation,’ said Sara Kropf, a lawyer in Washington, D.C., who provides legal advice to doctors regarding patient reviews.” This trial is scheduled for February.

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At first Dr. Guyoron wanted the patient to remove the reviews and pay him $700,000, which she said she didn’t have. He now wants $1.8 million.

Knowing the risk to your wallet, would you think many times before posting online a negative review about any doctor? Doctors aren’t infallible: they make mistakes as we all do. Should review sites investigate/vet patient complaints before posting them? What are other effective ways to warn other patients about a doctor you’ve found faulty?

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There are plenty of self-help books with titles like “Married…But Lonely.” And loneliness doesn’t just happen to the elderly, although seniors over 80 represent the largest percentage for understandable reasons: Lost hearing, sight, mobility, family and friends and many are isolated because they lack funds to socialize.

I didn’t realize the crucial impact of loneliness made clear in the lead to Emily Holland’s Wall Street Journal article: “Loneliness is hazardous to your health—and more psychologists and doctors are calling for a public-health campaign to fight it.”

In the article, “The Government’s Role in Combating Loneliness –Medical experts say social isolation needs to be seen as a public-health issue,” Holland quotes Brigham Young University professor Julianne Holt-Lundstad: “cumulative data over hundreds of studies with millions of participants provides robust evidence of the importance of social connections for physical health and risk for premature mortality.”

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Studies have shown that “the risk is equal to or greater than major health problems such as obesity.” Dr. Holt-Lundstad presented analyses of data from multiple studies at this summer’s American Psychological Association convention that “found that having greater social connections is associated with a 50% reduced risk of premature death.”

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According to Holland, an AARP study estimated 44 million adults 45 and up experience chronic loneliness. “In the survey, 35% of respondents said they were chronically lonely, up from 20% in a similar survey a decade ago.” Why? “An increase in single-person households, higher divorce rates and too much focus on social media over in-person communication,” may be some reasons.

Holland reported that loneliness doesn’t get the attention of smoking or obesity but that it is beginning to, noting the AARP public education initiative Connect2Affect. In addition, she mentioned a toll free number seniors can call to get rides via Uber and Lyft in some areas; a 24 hour, free Friendship Line–800-971-0016–sponsored by the Institute on Aging for those 60+ who feel lonely, depressed–even suicidal and programs at some senior living facilities that encourage socializing between generations.

Early detection and encouraging people to seek help are key to turning around the situation. Physicians must learn to question patients and patients must feel comfortable admitting their feelings of involuntary isolation and seclusion.

What is the difference between loneliness and solitude? Do you know people who are surrounded by humans and yet they feel lonely or others who prefer to be alone and say they are happiest that way? Have you heard of effective ways that infirm or financially strapped people of any age can remain involved?

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A friend wrote this post and the timing was perfect. It took two days for my husband to receive a prescription last week when it formerly took hours. One misplaced prescription spawned countless phone calls because the pharmacist never got the first digital request. Before the “new and improved” system—I wrote in April about NY State’s electronic prescription law–often meds were waiting for him on his return from his appointment. Thank goodness it wasn’t a life-saving medication.

She wrote:

Have you noticed that the support staff in many doctors’ offices seems overworked?  Because they are, you may have been on the receiving end of deep sighs, harrumphs, blank stares, disconnected calls or worse. And because these things happen so frequently, I guess we have to learn to live with them. But when, within a 24-hour period, three harried-health-care-worker incidents occurred that not only inconvenienced me but also potentially put my identity, my health and my mother’s health at risk, I got angry.

Bloody Irritating

The first incident involved a blood draw at a hospital that consistently earns a top ranking on the U.S. News & World Report list of top hospitals in the country. The patient who had registered with the receptionist just before me gave her a hard time about something. I wasn’t really listening but I was aware that the patient had raised her voice before storming out. I was next in line, and as I approached the check-in desk I instantly decided to be extra-nice to the receptionist, who clearly was frustrated.  I made some upbeat small talk as I handed her my prescription, which was written in typical physician hieroglyphs. She narrowed her eyes and asked no one in particular, “Why can’t doctors write more clearly?!” Since she was having difficulty deciphering his handwriting, she summoned a colleague for assistance. I watched as the second set of eyes narrowed, and then a what-do-you-think-this-prescription-says guessing-game commenced.  I quickly offered to call the doctor to get the definitive word about the prescription—which, of course, is what the receptionist should have done–but I was ignored. So, because I was facing a time crunch, I proceeded to the lab, had blood drawn, and then headed home. By the time I reached my house, there was a message on my answering machine from the lab manager informing me that they had not drawn enough blood because they had misinterpreted the physician’s instructions. As a result, I needed to return to the hospital. Not only was that inconvenient, it also left me wondering whether their final interpretation of the doctor’s handwriting was correct or not.

Facts? What Facts?

Later that day, I brought my elderly mother to an appointment with a pulmonologist. Although this was the first time she was seeing this doctor, he is affiliated with the aforementioned hospital, where she’d had several admissions. This facility keeps a centralized database of patient records, which is accessible to all doctors affiliated with the hospital. Because the doctor’s staff neglected to send us paperwork in advance, I spent 20 minutes entering mom’s current health data. She takes lots of prescriptions, and the dosages and names change frequently. As a result, she always carries an up-to-date list in her handbag.  At the conclusion of the appointment the staff gave us a report with test results and other info. My mother glanced at it and noticed that some, but not all, of her current meds were listed, and the report included several mistakes in dosages. I knew I had not entered incorrect info on my mother’s paperwork, so I asked the receptionist how all these errors had happened. Did the old records override the new ones? Did someone choose not to enter the new info because they were too busy? I’ll never know because I didn’t receive a coherent explanation. What’s the point of providing a list of a patient’s current meds if the info isn’t entered into the patient’s records? More importantly, how can a doctor make sound recommendations to a patient if the doctor doesn’t have up-to-date facts?

Vanishing Act

The third incident occurred the next morning at a surgeon’s office. I had been there at least five times over the past four months for treatment of a complication following a procedure. At my April appointment I provided updated insurance information and watched as the receptionist photocopied my brand-new Medicare and insurance cards. By the time I arrived for my next appointment, in July, that info had vanished. There simply was no record of it. When I told the receptionist which of her colleagues had photocopied my cards, I was met with blank stares. I ask you: Where does this stuff go??? The incident was disturbing because those cards included everything needed to steal my identity. Although the receptionist reacted with a shrug of her shoulders and a “yeah, this happens every day” attitude, their carelessness was a big deal to me because it has the potential to cause significant consequences.

I get angry and concerned when mistakes are made by health care employees because there simply is no room for error in their industry.  Am I unrealistic, or do I have a right to feel this way? More importantly, what can patients do to ensure that no one involved in their health care cuts corners?

Pick Another Word

The people who selected key words in the following examples didn’t think of their impact on others.

• In this first instance, the name of a clinic was selected from the point of view of health professionals. It didn’t have patients in mind. A friend, I’ll call her Nora, received a call from out of the blue from the “Survivorship Center.” At first she thought it was a scam and that the person on the line was asking for funds. She’d been going for checkups to the prestigious Dana-Farber Cancer Institute. During the call she learned that the nurse practitioner she’d seen for years was leaving the Institute and that she was now assigned to the Survivorship Clinic. Nora told me: “I don’t like being categorized as a ‘survivor,’ and I don’t want to be a card-carrying member of such a group. I’m not ashamed of having had breast cancer, but that I had it shouldn’t be part of my identity.” She was infuriated when she received a letter in the mail with the clinic’s name on it. She hasn’t blasted the news of her previous illness and resented that the postal worker saw the name of the clinic. She felt it was an invasion of her privacy. In a second call to this clinic Nora told the person she spoke with that she thought that the name was dreadful—even tacky. Her response was that Nora was free to go elsewhere.
• Then there was a word I’ve referenced before: Relocatable. That’s what the Air Force called a certain type of housing back in the day. The word focused on how the structure might be easily moved with no regard to how it sounded to people asked to live in it. It had no appeal to those assigned to the punishing North Dakota climate known for minus 60 degree temperatures and ferocious winter winds. The word implied flimsy and evoked images of belongings flying in the air should a Wizard of Oz-strong cyclone hit. Many of the relocatables remained empty in spite of a base housing shortage.

Redundant: You Are or You Aren’t

• I sat up straight when I heard a supporter describe a political candidate as “very, very honest.” There are some words that need no embellishment. Honest is one of them.
• 

  Queen Anne-style armchair

  With furniture, if a piece imitates an original, the word “style” clarifies what it is, as in “Victorian-style chest,” or “Queen Anne- style chair.” But a doctor, artist, PR person or bus driver is or isn’t.

• In this context, early one morning last week Len Berman told his listeners about a UK-based company that is now set up to work in NYC to fight parking tickets. It bills itself as “the world’s first robot lawyer.” As the WOR-Radio co-host of “Len Berman and Todd Schnitt in the Morning” read copy about this service he hesitated after saying “A real lawyer” and repeated, “real lawyer?” then continued. I, too, would have paused. Is there an unreal lawyer?
• 

  Len Berman

  Do certain words that name a service, organization or product rub you the wrong way or create a negative image? Do you think that let-it-all-hang-out TV programs, where people share the most intimate information about themselves, impacted the choice of the Survivorship Clinic’s name?

“The lady doth protest too much, methinks,” said  Gertrude, Hamlet’s mother, which I thought when I heard “very” matched with “honest.” Other examples? What about the reference to a “real lawyer?”

Claire Bloom as Gertrude

Umpteen articles and op-eds have been written about malpractice lawsuits. I found Laura Landro’s Wall Street Journal piece heartening as she described how doctors are using the information to improve care.

This approach is clearly a benefit to physicians to alleviate the number of distracting and time-consuming lawsuits made against them but as a patient, I was glad that someone is learning from the mistakes to prevent future instances. I also hope this initiative is nothing new.

In “Mining Malpractice Data to Make Health Care Safer,” Landro reports on a 2013 study that doctors spend “11 percent of a 40 year career with an unresolved, open malpractice case.” Scarier is the statistic that “250,000 deaths a year are due to medical error.” This, according to Landro, came from a recent article in BMJ that noted findings by Johns Hopkins researchers. Commonly the causes are misdiagnosis or “poor technique in a procedure.”

Landro broke out what doctors in a few specialties have learned:

• Usually overweight mothers matched with larger babies can cause shoulder injuries to infants if they get stuck inside the mother. By identifying those who might be at risk for this set of circumstances, a hospital and doctor can address the option of a C-section early.
• In the ER, one doctor noticed that “failure to explore a wound that was infected or contained foreign bodies was a key factor in many cases.” Now a doctor in that hospital must check a wound after a nurse or PA attends to it and before it’s sewn up. They noticed that this, alone, didn’t do the trick because sometimes they miss, say, a stingray barb. Therefore patients must be instructed to return to the hospital if they don’t feel well.
• In cardiology, blood thinners cause problems because “patients haven’t been properly educated about the risks and didn’t understand follow up instructions.” And when more than one doctor is involved, each may think that the other one has taken care of communicating this information. The solution was to ensure all patients on blood thinners are “‘set up with effective management,’” wrote Landro, quoting Dr. Sandeep Mangalmurti, a cardiologist.
• Follow up is also crucial in knee and hip replacement cases where patients don’t “adhere to a treatment plan or keep follow-up appointments.” A third of cases involved injury as a result. One doctor and his group use a mobile app to send reminders to patients about making appointments and follow-up procedures.

By the end of the article we read that improved communications between doctors and patients is paramount. To that I must add a loud “duh.” Isn’t this a tall order in a system in which patients see a doctor for minutes a visit and often a different doctor each time?

• Doesn’t a lot of what the doctors found went wrong repeatedly seem like what common sense should have prevented?
• Would you be less likely to start a medical malpractice suit if you felt the physician and his/her team had done everything possible to care for you or a loved one?
• Have you ever felt that a health care professional treated you or a loved one indifferently—that you were lucky nothing tragic happened as a result?
• Have you heard of initiatives that take advantage of such date, like these?