Your Last List

Anyone can make long lists of things they don't want to do. On the top of mine you'd find colonoscopies, but after participating in #EOL chats with @DrBeckerSchutte over the past year and the #HCLDR chat from November 26th it's evident that making my wishes for the end of life known is what really stands at the top of the list.

Obviously this is not my stone but it was a surprise and a warning note to see it.

Having worked in a bank for years when I was young I am well versed in starting a conversation about wills and executors. The main reason that resonates with people is that if you don't make your own choices about your money and possessions in a will, the government will step in and take care of it for you. That's not a popular choice.

As for executors, that too can be a delicate problem that can tear families apart.  And yet people take far more care planning the financial issues than they do with their lives.

The quality of life you have at the end of it depends on choices that are made, and who knows better what you want than you yourself. 

My dad set a great example of planning. He made sure that he had done a Power of Attorney for both financial and health decisions for himself and my mom, as well as a will. He also planned his funeral and hers in as much detail as made sense. This was a huge relief when they did die. We could concentrate on family, not the business of funerals.

It was wise of him to do this early. No one could have foreseen my mom's stroke, and her long survival after my dad died.

So this is a call to people who read this to start having discussions about the end of life. 

It will happen to us all.  Studies show 80% prefer to die at home and yet 60% die in a hospital and only 20% die at home.  The figures for survival after CPR are dismal in the elderly - it's really meant for young healthy people.  If you have not chosen to "Allow Natural Death" (AND) or "Do Not Resuscitate" (DNR) you will get the full 'benefits' of modern medical technology even when you would die shortly no matter what is done.

More interesting reading.

How Do Physicians and Non-Physicians Want to Die?

The Other Talk - About talking to adult children about the way you want to live the rest of your life.

The information above is very influenced by the Tweetchats I mentioned, especially a tweet by @ChadCampbell119 when he said "I think including #EOL in basic education like we do with mammograms, colonoscopies etc. Preventative is better. Don't wait till too late."

He also Tweeted this link that discusses what to do with a loved one's online accounts after death. It's very relevant to those with a rich virtual presence.

See the One Slide Project and HealthBlawg for ideas about the questions you should be asking yourself and your loved ones. I jumped into this post with enthusiasm, not really absorbing the years-long tradition of the "Engage With Grace" Project each Thanksgiving. The answers to the "One Slide" will take you a long way towards a decision.

HCLDR Chat and Healthcare Mystery Shopping

Feedback from consumers and providers is a great way to make an organization work better for everyone. Once you start thinking about using these insights great changes can occur -- if there is a will to use it.

This should work in healthcare. A great discussion about the topic of patient feedback can be found here in a transcript of the #HCLDR tweetchat from Tuesday August 13 at 8:30 pm EDT. Below are the top 10 participants by mentions.

• @practicalwisdom @colin_hung @teammdrs @soulmirror @dandunlop 
• @jcs0716 @docnieder @joshgray_hcit @strangely_t1 @ruthcarlosmd  

I had a different type of experience in feedback after my diagnosis with RA. When my symptoms improved I noticed a small ad in a newspaper looking for part-time mystery shoppers. I answered the ad and a meeting was set up by the coordinator at a restaurant near me. Despite being somewhat dubious I accepted the job.

It was purely corporate information gathering for the purpose of quality control at a distance. I felt sneaky, like a gumshoe doing a job, but in an underhanded way.  At least the experience in critical evaluation and customer service was invaluable.

My assignment was to go to certain walk-in medical clinics as a new patient and evaluate all aspects of the experience. These included the signage and accessibility, and the staff from receptionist to doctor. The thought of evaluating doctors was totally new to me, and a little daunting. I was not sure it would be easy to critique authority.

In the Canadian health care system my Health Card would normally enable me to walk in, show the card and see the doctor. This job though was being done for a corporation doing market research so I needed a story that let me pay cash for the visit.

I said I had recently moved from Quebec to Ontario and had no Ontario Health card. This way I had to pay.  Letting Ontario tax dollars pay for my "care" would have been fraudulent.

Part of the job was phoning each clinic from a list I was given and asking questions. I felt sure some of the receptionists were able to tell I was a designated shopper.  One was rude and silly on the phone and I understand he was subsequently replaced.

I would love to give useful feedback about many of the healthcare facilities I see now. Cleanliness, signage, friendliness,efficiency and neatness were among the areas rated in that past job. The compliments would probably outweigh the complaints but I see things that could easily be improved.

Some of the doctors were outstanding.  Those who impressed me most showed interest by asking more questions. They involved me in my story instead of taking it at face value and sending me away with a prescription. The good ones seemed to want me to leave with more knowledge than I had at the start of the appointment

RA was a convenient reason for seeing the doctors. I told one I was taking 9 aspirin per day. He told me he personally would always take coated aspirins to protect his stomach. 

 with ring splints

Another time I told the doctor I was depressed because I had actually felt that way after my diagnosis. That did not work so well. Even though the story hung together the doctor commented that I was smiling more than he would expect to see in a depressed patient. He was right. I was having fun doing the mystery shopping because I found it so interesting at the time. 

Now the chain of clinics is gone but it left behind an interesting memory for me.

Exercise and Patient Engagement

Of course I plan to start exercising soon.  Here's my exercise bike almost ready to go. I'll use the pylons to keep people out of my way.

                                                                A McKinnon
Given the frequency that exercise and physical activity is recommended it should be heralded as the new wonder drug. In fact it may actually be running ahead of patient engagement in the wonder drug category.

So imagine what an engaged patient who exercises can do!

                           a longer than usual walk today             A.McKinnon

Prescription For Exercise

Last week in the #hcldr tweetchat participants received this prescription for health from Dr Tony Leachon. This is all you need to do to be healthy and live longer.

Thanks to Dr Leachon

From Dr Leachon's tweets I can see he is truly committed to changing viewpoints on disease prevention from the top down. Do you think that when it's a prescription we pay more attention?

Just kidding about the bike but I do exercise. There is nothing wrong with my core so I try to strengthen it to gain muscle and improve my balance. I do a modified form of Pilates while taking care not to stress my back because of worry about osteoporosis. This article by Sherri Betz about Modifying Pilates For People With Osteoporosis works as a guideline for me.  I worry about it because of my family history of back problems.

                                My back mascot - Bone Buddy  A.McKinnon