How To Develop Chronic Patient Syndrome

There are many stories about waste in healthcare. Some are ridiculous and some are based on misunderstandings and lack of knowledge.

Here's my waste story: While I was being treated for RA, injectable methotrexate was prescribed for me because the pills caused too much nausea. The shots were intramuscular and I assumed that I needed to have a doctor administer the injections just like with gold shots.  

So every Wednesday afternoon I would leave work early, go to the doctors office, park and wait (and wait). This went on for seven years. That means 364+ extra doctor visits and at least 1000 hours of my time that was wasted. Not to even mention the white knuckle winter trips.

                                    www.transportation-tech.com

My rheumatologist then happened to suggest a clinical trial.  As part of the start up process for it I met with a nurse for an interview and in the course of the discussion she asked why I did not inject myself. Thank goodness she did. 

I had seen at least 10 different doctors in those 7 years, allowing for travel, locums and vacations and not one of them said a word about this possibility. At last I was spared the weekly visit!

That is why I suggest that in some chronic diseases there should be a resource person or advice line, ideally staffed by a nurse who has the time to discuss treatment choices, possibilities and ways to make life with a chronic disease easier. If it had not been for that one nurse a lot more time and productivity would have been wasted.

Lego Nurse

This new service would give non urgent sensible advice to patients with chronic illness online or by phone. Of course the answer may often have to be "Check with your doctor" but even that is a helpful answer because you have an opinion on the relative seriousness of the question.

And with a few stories like mine resolved every week the position would pay for itself.

Of course seeing my doctor for those hundreds of extra visits has led to us having a very good relationship based on my chronic patient syndrome. Yes, you develop that "disease" by seeing the doctor often.

Goals and Encouragement in HealthCare

Communication and collaboration between doctors and patients is a topic that I am happy to see in Tweetchats. In the last #HCSM on Sunday evening, August 18 at 9:00pm the final question dealt with goal-sharing with healthcare practitioners. Is there standardization, how are goals communicated to HCPs and what if the goals that the doctor has for the patient are different from the patients' goals?

This link leads to a storify (my first one ever) of some of the enlightening responses. You can see some of the responses for yourself.  Tweetchats are an outstanding way to get a view of a subject from more than one perspective.

                                   Iris                     AMcKinnon

It was a fascinating topic and my favourite story was by Dr. Iris Thiele Isip Tan. Her patient was so excited to reach her goal that she jumped up and hugged her. So achieving the goal empowered the doctor and the patient! as Dan Goldman said. And neither will forget the moment.

That is the ideal result of collaboration between doctors and patients to reach goals.  

Which brings me to what I think is the secret ingredient that helps people become more literate and engaged.  Encouragement. When people manage to achieve even a small step on the road to improvement some congratulatory words from the doctor are a real accelerant for many. 
Here's a commercial for encouragement. I just saw it through reading RA Warrior's blog this morning. Being encouraged is often an exceptional event. We can all make it more common.

Here are some guidelines to goal setting:

 

Whether your goal is climbing a mountain, planning a party or improving your health there are ways to reach that goal.  When you take a self management course you find out that goal setting is one of the most useful tools in the chronic disease management kit. 

                                     Wait! Do I need to open the box?

There are no secrets to effective goal setting - just guidelines to help you succeed.  You can chose something very difficult but then break it into achievable steps. That's your Action Plan. Then work on each step one after another.

1. You need to be specific about your goal. Not "I will lose weight next week" but "I will not eat after dinner on Monday or Wednesday" for example, or "I will walk for 1/2 hour on Tuesday and Thursday in the evening".

2. As in the example above you want to be able to measure the goal. Not eating after dinner on two days is the goal and it is easy to tell if you succeed.

3. It also has to be realistic and achievable. If you know in advance that you will never accomplish it you need revise your goal. A rule of thumb is to rate the likelihood you'll do it on a 10 point scale. Your confidence should be at a 7 or better.

4. Your goal should be relevant to you and your plan.

5. Making it specific as to time is also a proven method of making your action more likely. 

Even with these you should think about what obstacles or setbacks might come up and make a plan for that too. If there's a surprise party and you need to eat cake you could choose another day to abstain from sweets.

                        Digital image courtesy of the Getty's Open Content Program
 

Climbing this mountain in one day would be beyond me now but I'm sure I could do it by preparing gradually.

Good Luck on your new plan!