Patience


All things, I think, do not come to those who wait. What about Godot? Or that Smith-Corona stock that seemed to be such a nostalgic good idea?

Waiting was not always totally painful. Back when you knew Santa would bring at least one or two joyful surprises, or when the late-night radio personality you were dating spun the sign-off music and was headed to your apartment, that old Patience Is A Virtue adage nailed to your brain by your grandmother wasn’t all that menacing.

But patience today is increasingly hard to come by.

Nancy Pelosi recently called a press conference in San Francisco, targeting faith community leaders and hosted by the San Francisco Interfaith Council. Held in the serenely peaceful sanctuary of a small Episcopal church, the event drew almost as many police, security and media types as everyday-citizen audience members. I was among the latter. (I have only recently learned to request a press pass thanks to my True/Slant blog certification and thus be permitted to arrive late and sit up close. But that still seems the height of arrogance so I generally pass on the privileges of a press pass.)

Told the conference would begin at 10, we were asked to arrive by 9:30 at the latest. I showed up at 9:15. At about 9:45 the word circulated among everyone milling about in the church courtyard that the conference had been postponed to 10:30. At 10:30 we were sitting in the quiet room. At 11:00 the word circulated that a “roundtable” discussion with selected faith leaders was underway in a room downstairs. At 11:15 I asked if there were any indication of when things would get underway, pronouncing myself (to the staffer who periodically appeared and said things like “Please don’t get in the way of the TV cameras”) too angry to hang around much longer. About 11:30, Speaker Pelosi and the roundtable participants appeared, speeches were made, a few questions were asked.

Here’s the rub: I am on Nancy Pelosi’s side. I fervently support – actually, have been Secretary of the Board forever – the San Francisco Interfaith Council, and I desperately want healthcare for all, which was the topic of the conference. I even understand about security issues and tight schedules and all that.

But patience is increasingly hard to come by. I hope impatience doesn’t cost us too dearly.

Celebrations, changes and challenges

The quietude of this space of late is in direct proportion to the activity, at long last!, over at my new blog on True/Slant.com. Boomers and Beyond (you’re invited to visit) looks at issues of concern to seniors and, increasingly also to their boomer children. Health and healthcare, housing, fitness, economic survival, liesure & recreation. We’re open to suggestion. True/Slant is a still-developing all-journalists news aggregate site I think will continue to grow stronger and more useful. With the necessary little www preceding it, trueslant.com/franjohns will take you to my page.

In the meantime, I hope to keep an occasional post over here at the Celebration site. It’s a joy to have a spot in cyberspace on which to ponder anything that might seem worth pondering; it’s even more joyful to get paid (!) for it.

Hope you’ll surf over to True/Slant whenever you can. Hope I’ll still find time to post, here, things that seem too far-out or too quirky to toss up on a serious news site. Over here on Celebrations, I still need to get to the meringue cookie issue.

A Novel Path to Better Healthcare

Here’s a revolutionary idea: “Ask the patient.”

This suggestion was made recently by the President’s Council of Economic Advisors Chair Christina Romer in a speech on “The Great Credit Freeze and the U.S. Economy.” The talk was all about improving healthcare while slowing down the growth of its cost. We know we can’t reduce costs, Dr. Romer said; what we hope to do is reduce the rate of increase. And one way to contain healthcare costs might be to find out what the patient wants. Imagine.

This comment was not in direct response to a question, but could well have been. Dr. Romer was asked, by more than one audience member, about how to address excessive expenditures at the beginning and end of life. A grossly disproportionate share of costs, she conceded, “are spent on the last six months of life. And one thing we’re not doing enough of is letting patients express what they want.”

If the issue were not so grim and sorrowful it would call for a “Well, duh.”

It would be hard to find many people who would say they’d like their last few days on this planet to be spent semi-conscious or in pain and distress, hooked up to a tangle of wires and tubes in a blue-lit hospital room. But this is in fact the system we have created: we focus on prolongation of life without regard to quality, we aid and abet doctors who equate death with failure, we never talk about our own mortality as if in silence we can become immortal. Most of us would choose to die at home, properly medicated for pain and surrounded by our loved ones; most of us will die in an institution

Audience members had a wide assortment of questions, and Dr. Romer had plenty more to say. But finding out what the patient wants, and acting accordingly, is surely one excellent path towards better care – and even contained cost growth, and everyone in America could begin that process today.

It is an easy solution, even if only a small, partial solution, to this piece of the muddled medi-puzzle of our healthcare system: talk. Tell your doctors, caregivers, loved ones what you do or don’t want. Write it down. Use the forms universally available (Advance Directives, POLST, others.) You might even wind up with what you want in your final days. Christina Romer is on your side.

Health Literacy

Health Literacy, which is as much about common sense as about the three R’s, can nevertheless be a matter of life and death. Rebecca Sudore M.D. covered the issue in a recent talk to a group of healthcare professionals and volunteers in which she included video clips and verbal summaries of cases that bring chills: a woman who didn’t know she was having a hysterectomy until after the fact because she was afraid to ask questions, people who suffered or died simply because they could not read the details about medications or procedures. Health Literacy may be a field still in its infancy but it is a topic, as well as a separate professional discipline, for which the time has come.

Dr. Sudore, whose youthful energy and unassuming demeanor belie an impressive list of credentials in geriatric scholarship and practice, is passionate about the subject. Among the messages she shared, here are just a few:

Health Literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” In other words, if you’re sick or wounded, it’s a pretty good idea to understand what should or should not be done to you – and literally millions of Americans do not.

Millions? Really? Yep, between 40 and 44 million of us are somewhere around a fourth-grade learning level, cannot read signs or medication bottles, poison warnings or the schedules of city buses. Try to imagine making it through the day, if you were in this group, with a bad cold or an infected finger. Another 50 million or so of us are hanging around 4th to 8th grade level, which means we have trouble with “executive functions” such as simple forms or reading a magazine. I hold an advance degree, and don’t even get me started on the difficulty-with-forms issue. If that form, though, means whether or not you agree to a hysterectomy it’s a lot more serious than exchanging data or filing your taxes. Healthcare workers, and sometimes family and friends, must pick up where education or language skills leave off.

Patients, Dr. Sudore explains, are critically hampered not only by lack of education and skills but by shame, fear and a host of other issues. Doctors, often part of the problem, are hampered by lack of time and health-literacy training, and other issues of their own.

Dr. Sudore and her fellow crusaders are out to change all that. They preach keeping messages simple, using plain language, an “Ask-Tell-Ask” method of communicating. Dr. Sudore was pleased, recently, to encounter a physician who caught himself hurriedly saying “Any questions?” to a patient and then corrected the phrase as she had told him, “What are your questions?”

It may be a way off, but Health Literacy is gaining ground.

1 6 7 8