Sunday, August 16, 2009

Counselors and Clients: Can't We All Get Along?

The Worcester District Medical Society published their recent magazine (July/August 2009 edition) entitled, "Worcester Medicine-Health Professionals and Patients: Can't We All Get Along," (Part 2) that printed several articles on different topics pertaining to the doctor/patient relationship.

One particular article entitled, "Understanding Humiliation" by the Dr. Aaron Lazare, MD, talked about how diagnostic labels such as hypertension, heart failure, psychiatric disorder, just to name a few, can be demeaning and decrease a patient's sense of dignity. Some of the patients he interviewed responded to his question, "How did the situation that brought you here (hospital or clinic) make your feel?" Some of their responses were: "like an animal," "like a welfare patient," "like I did not matter," "like a person without any rights," and "like a nobody."(P.11). Further, some patients also felt degraded when their doctors criticized their behaviors such as excessive drinking, weight gain, etc.

Dr. Lazare's attributed some possible reasons on why doctors and medical students may respond to their patients these ways:

* Not enough time with them(patients)
* Their (Patients) unreasonable expectations and demands
* Doctors/Medical Students feeling inadequate as a result of their own personal issues of perfectionism and dealing with overwhelming knowledge of information they need to know in their jobs
* Fear of malpractice suits

How can doctors learn to be more self-compassionate people with their patients?

Dr. Lazare teaches doctors about the emotional impact of humiliation on their patients as well as for themselves. Dr. Lazare's talks about the importance of offering an apology when appropriate and admitting to making a mistake to your patients. This solution makes patients feel that their doctors care about them by increasing their trust in them and being able to be more open with their doctors.

What can counselors take from the above information: I look at this opportunity as threefold:

1) Counselors can become more self-aware of how we treat our clients when we are feeling pressured on our jobs. For example, if you work in a family clinic, you are required to fill out treatment plans and quarterly reports in order to be paid by insurance companies. Other examples include taking on more clients to make a "liveable" income and responding to emergencies that can take all day to resolve, that is, if it is solvable. For those in private practice, the pressure can be to recruit and to retain prospective clients to stay in business. Other issues are trying to balance some of your clients' unreasonable and high demands for therapy outcomes due to their investment and time in seeing you. We need to be cognizant if we offend our clients in anyway and offer offer an apology
when appropriate.

2) Counselors need to be sensitive to how they process their clients' diagnoses with them. Sometimes, counselors can forget that the client is a person first before the diagnosis. Counselors also need to empower our clients to not be stuck with the "labels" but to see it as a small part of themselves that they need to manage on an ongoing basis.

3) Counselors can teach their clients that they have the right to be treated with respect and dignity at the hospital and in the doctors' offices. Counselors can refer them to the appropriate resources that can help them resolve their complaints if they choose to file one. Counselors can also work with them on their feelings of humiliation they experienced and to teach them coping skills to decrease their symptoms. However, if some of your clients act inappropriately in these places, you need to work with them on how to be more patient and to act in a dignified manner with an imperfect healthcare system.

I would like to see articles on teaching counselors similar communication and customer services skills that medical students and physicians receive in hospital settings.

What do you think?

Robbin Miller, LMHC

Tuesday, August 4, 2009

Controversial Health Insurance Reform Forum

I had the opportunity to be invited by Congressman McGovern's office to attend the Health Insurance Reform Forum at the University at Massachusetts Medical School today, 8/4/09 from 330-5 PM. Besides getting a lost due to poor logistics on finding the appropriate amphitheater and being appalled by the lack of adequate handicap accessibility for persons with disabilities, this forum achieved some of its goals in explaining the nuts and bolts on the proposed health insurance reform that is currently sitting in Congress.

The room was full and standing room only. Fortunately, I followed a few people to the platform level where I was able to hear the speakers and not see them. Later on, I was told to go to the fourth floor amphitheater where I was able to sit in an air conditioned room and see the speakers on the screen.

Some of the participants in the audience were loud, rude and disrespectful toward both Congressmen Richard Neil (from Springfield) and James McGovern and to each other. An UMass official told the audience that if those participants did not clamp down and stop their heckling, that both Congressmen would be escorted from the room and the forum would end.

After the brief 15 minute fray, things quieted down and both speakers were able to present their support of health insurance reform. Here are some of the points on why they both support changes:

1) The current system of health care is broken
2) The status quo is not working
3) 16% of Gross Domestic Product(GDP goes to healthcare costs; by 2040, health insurance costs will be 50% of the GDP. If this becomes the cost, the federal government will have difficulties paying for education and other costs that are important for Americans to have.
4) Drug costs are increasing exorbitantly.
5) The donut hole in Medicare is unaffordable for many seniors and for persons with disabilities

Here are some points that were clarified and supported by both speakers for health insurance reform:

1) The current Bush medicare "donut hole" for seniors would be changed. Currently, the Department of Health and Human Services (HHS) is forbidden under federal law to negotiate drug prices with drug companies. If bill is passed and would be effective in 2013, HHS would be able to negotiate for lower drug costs.

2) The myth or misunderstanding that patients would be mandated to have "End of Life Care" discussions with their doctors is false. Both speakers emphasized that these discussions are voluntary and the doctors will be able to get reimbursed for their time with their patients. It was noted that End of Life care is very expensive in particular for a young 25 old male (as an example) who gets into a motorcycle accident and has no health insurance to cover his costs. This position sort of makes sense to me as I understand why "the morphine" is sometimes pushed with hospice patients to get them of their misery. If they on Medicaid, it is cheaper to end their life sooner, as a cost-saving mechanism for the government. I also understand that this issue is controversial and very taxing and emotional for some family members to deal with.

3) If you have your insurance plan and like it, you can keep it. A participant yelled out, "How long?" Both speakers emphasized that nothing would change for them if they like their health insurance plans.

4) Incentives would be given for doctors to enter the primary care field as there is a current shortage of them throughout the country. The same is for increased recruitment of nurses for the same current economic conditions.

5) Increase emphasis will be on promoting and using evidence based practices to reduce costs and increase quality for patient care. An Independent Board of physicians and experts would conduct studies to evaluate the cost effectiveness of using evidence based practices that are not influenced by drug companies and special interest groups.

6) Overall, the gist of health insurance reform is to promote prevention, to increase responsibility on the individuals to purchase health insurance, and to improve the quality of care using cost-effectiveness evidence-based practices in reducing costs to the government and to taxpayers. To do nothing as both speakers stress, will result in higher taxes for Americans and maintain the status quo.

What do you think?

Robbin Miller, LMHC

Saturday, August 1, 2009

Calling a Person with a Disability an Inspiration:Is this an inappropriate comment?

As an advocate, I am not comfortable when the general media calls a person with a disability "a story of inspiration" and " accomplishing a heroic feat." These terms in my opinion are offensive and actually put down a person with a disability. A friend of mine who has a mobility impairment said that a person with a disability is either looked at as a "hero" or "as shit" by the community. She said an individual with a disability needs to be looked in the "middle" as a person just like anyone else who does not have a disability.

How about if articles labeled a person without a disability as a TAB-Temporarily Abled-Person when writing about their issues in the general media? How would the community respond to this?

Many healthcare professions also believe that motivating their clients to arise above their disabilities by performing "extradordinary" feats will make them feel better. This is wishful thinking and can actually cause more harm than good. What about if this person does not accomplish this "feat' than what?

I have been actively advocating that "Disabilities" become part of the "Committee on Healthcare Disparities" for minority groups in Massachusetts. At press time, I don't if this legislation was pass to include "Disabilities" as part of this committee.

What do you think?

Robbin Miller, LMHC