Patient Centred Care - It Begins with Respect

Patient Experience. Empathy. Patient Engagement. Patient Inclusion. Shared Decision Making.

I hear a lot of buzzwords. And a lot of the time, that’s all they are – buzzwords. I’ll tell you what I want, not as a ‘e-patient’ or a ‘patient advocate’, but just as a mom. I want my 14 year old son to leave his 2 hour appointment with his new doctor excited about the care he’s receiving. And that rarely happens. But last week it did. Why? What was different?

In the words of Inigo Montoya from ‘The Princess Bride’ “Let me 'splain…No, there is too much. Let me sum up…”

Our names were respected:  

Right from first handshake, he respected our names. He checked with my son, his patient, how he likes being referred to and made sure to use that name. Amazingly, I was not ‘mom’! I was Ms. Jordan. I had a name – like a respected colleague. Even our family members that weren't there – he took the time to find out their names, to ask the spelling, to check in to make sure that the had it correct. It seems such a minor point, but if you were going into a collaborative business meeting, wouldn’t you make sure that you had the names of your partners right? Would you go into a project with someone who couldn’t be bothered to figure out which was your first name or last name? Names matter. Manners matter.

Our emotional needs were respected:

In recognition that this was to be a long appointment, this new doctor told us exactly what the agenda of the appointment would be. Of course he knew, but respecting our needs as partners meant bringing us in the loop so that we could have a say. And then giving us (giving my son) the power to change locations/moving/pausing if the appointment became too long. Of course, as with most people, knowing what was coming next made it easier to tolerate a long meeting and we were fine with the long appointment time.

Our physical bodies were respected:

Recognizing that the clinic is truly the health care provider’s domain is important. And inviting the patient into it and making us feel comfortable there isn’t something I’ve ever really thought about before. But at this appointment, this doctor said, “I’m comfortable, but others find it cold here. We can move to another room if it is too chilly here. That is no problem”. I don’t think I’ve ever been asked anything like that at other appointments. Furthermore, before examining my son, there was always a pause, an explanation, and a request for permission. Such a small touch, but an indication of respect and partnership and caring.

Our stories were respected:

So at the beginning of the appointment I did what I always do. I shuffled my papers. I organized my files and I got ready to be as efficient as possible, because I have been taught to respect the doctors’ time. Amazingly, this is the response I got (paraphrased) ‘I love data, but before I look at that, I want to hear your stories. [looking at my son] Your story. [looking at me] And your story. And then when you hear my story too, perhaps together we can reach some answers. Not because any of us are telling the truth or a lie, but because each of us has a different perspective.’ I’m sorry, but has this fellow come to see my talks or something? Seriously, he was preaching to the choir! My son and I may have shared a significant look at this point.

In brief, we were treated as partners in my son’s care; as respected equals, as colleagues. I don’t understand why this is both difficult and rare. I didn’t get the sense we were treated this way because we were special patients. I believe this is simply how this doctor treats his patients. To put icing on this already truly fabulous cake, the doctor asked us if we’d like to stay in contact by email so that we can see how a course of treatment is going and course-correct if necessary. Imagine. I am immensely grateful to this doctor for this experience. It reminded me of what is possible. We are fortunate because we have several healthcare providers that are doing so many things right. But this appointment, this day, distilled each of those things into one, single appointment. It made me see how important it is to feel respected in all of our interactions with the health care system. It is something we should expect, not be surprised by.

Respect. Being treated with manners and grace. This is simply how I expect my children to treat others. Isn’t this how we should expect health care providers to treat us as well?  

And in the end strength and joy will win

You were supposed to be the easy one - my typical child, running around with your friends, the world your oyster, the usual bumps and bruises of childhood. Sure there were those scares of your toddler and pre-school years, but we got past them and decided to forget them.

But suddenly things changed as the world has suddenly become not your oyster. As you're growing farther from the protected circle of friends who built you up and let you know that your dreams are your reality and you just have to work hard to see them happen. Suddenly the world opens and the monsters of doubters who don't bother knowing you but just see your external shell tell you that you're not good enough that you have to be different, that just for skin that you inhabit you have limits that are not of your own making.

And we have to patch those wounds and remind you that your dreams are your reality and those who use words to put you down and try to wound you are shadows that pass and you are the solid one who inhabits your life.

You were supposed to be the easy one but I forgot how hard it was to grow up and that things didn't magically get better and the lessons that I learned can be shared with hugs and with love and with words of power and strength. And that nothing worth getting is gotten easily and no, not everything is easy but you are strong and beautiful and joyful.

And in the end that joy and strength will win.

A Wish Fulfilled

It was the most perfect of days - sunny, a light ocean breeze and smooth sailing ahead. A lot had to come together to make the day happen, and it was perfect that the weather cooperated to put the finishing touches on the day.

Making Zach's Wish come true wasn't a sure thing. We didn't know until a relatively short while ago that as kid with no diagnosis, he was even eligible for such a thing. We were so used to falling between the cracks in the system that it would never had occurred to us that Zach could have a Wish granted. However, not too long ago, The Children's Wish Foundation contacted the Rare Disease Foundation to let us know that they had changed their eligibility requirements. More children in our rare disease community were now eligible to be nominated for wishes. This news was greeted with great excitement by my friends and we cheered when one, and then more of our kids were approved for wishes.

We were honoured, but tried not to get too excited when a dear friend in our community nominated our 14 year old for a wish. Having no diagnosis and no clear prognosis meant that getting approved wasn't certain, and we didn't want to make any assumptions. We were beyond thrilled when Zach was approved to get his Wish fulfilled. It has been a really tough year and thinking of what to wish for was exactly what he needed.

The rest of the family tried not to lobby him too hard for what we wanted. And even if we did, have you ever tried telling a 14 year old what to do? In the end, Zach's Wish wasn't surprising. He's wanted to be a marine biologist since he was about eight or nine years old (before that, he wanted to be a 'scientist of everything').  Zach decided he'd like to go on a marine biology adventure. And not just any old marine biology adventure. I had been following a marine biologist on Twitter, David Shiffman (@WhySharksMatter), for over a year and sharing what I read with Zach and his 11 year old sister, Evie. The kids were hooked - stories of working towards conserving endangered sharks by catching, tagging and doing the coolest of science? What's not to love? Zach wanted to go tag sharks with David. I'll say this for Zach - he doesn't think small. Would Children's Wish Foundation be able to set that up? Would David Shiffman be available? Twitter had informed me that he was finishing up his PhD - he had to be a pretty busy guy.

Unbelievably, it all came together. Children's Wish Foundation is a spectacular organization that took care of us so well. They arranged everything to make our trip go smoothly and make sure Zach's physical needs were taken care of so that he could really enjoy his Wish. Amazingly, some of our family that lives in Florida and Alabama were able to meet us there for a little family reunion. David generously gave of his time and met with us for dinner before our official Wish adventure. Honestly, the kids were star struck. And to put the icing on the cake, there was room on the boat to invite our family along to do some shark science with us on Wish day. The only thing better than getting a Wish fulfilled, is getting a Wish fulfilled with family.

And that brings us to our perfect day.

We were team 1: My family (myself, my husband Tyler, our daughter Evie, and the man of the hour, Zach), my mom (Meema), my brother, José and his daughter Katelyn.

Pics by Jeff Palumbo - sharktagging.com

We were told what our jobs were, how to be safe and what rules to follow. We needed to figure out which job each of us would do. I know I was feeling excited and nervous and happy. Would we catch any sharks? Would we be helpful? Would I screw up? Would I ruin the Science? We divided ourselves up into the jobs that we were allotted and waited for our chance to jump into the well oiled machine we intended to be. And hoped not to Keystone Cop our way through it!

We waited, hoping that at least one shark would be caught... because, you never know, you can't control nature.

When the first shark was caught, we sprang into action. It was a nurse shark! She was beautiful! We all did our jobs and I don't think we messed anything up. They coached us all through what we needed to do and this beautiful animal was released back into the ocean with minimal fuss. As she swam away, Zach threw his arms in the air and shouted "Wish Fulfilled!"

Pics by Jeff Palumbo - sharktagging.com

A note from Zach: It meant a lot to me that Children's Wish & the SRC were able to do this for me.

Unbelievably, through the course of the day 5 different species of sharks were caught, 9 sharks in total. We knew something special was going on when the biologists on board were excited!

Pics by Jeff Palumbo - sharktagging.com
A note from Evie: When I saw the first shark, it was like it was the day was done, I was so happy.
And then we saw so many more! 😃

Our family was thrilled to be part of the action and to be allowed to actually participate in the data collection activities. The best part was the intellectual and social generosity of the graduate and undergraduate students there, as well as the crew on the boat. No question was ignored and no inquiry was regarded as a waste of time. My young scientists' curiosity was rewarded with respect and enthusiasm. I can't say enough about what amazing role models the SRC team were to our kids. Their enthusiasm for their work and respect for each other and what I hope my kids have, whatever they choose to do in their lives. I'm grateful that Zach chose a Wish that had such an impact, not only on him, but on his sister and his cousin as well.

We don't know what the future will hold. Honestly, who really does? But this trip let our family do what we enjoy most together and what has become increasingly difficult lately. We had an adventure. We were outside together, experiencing something that was totally new to all of us and learning together. We had the joy of discovery and had it as a family. Zach's Wish to take part in shark science research was a welcome break from a daily focus on healthcare management. It was an injection of fun and curiosity and excitement that I think my kids deserved.

We are incredibly grateful to the Children's Wish Foundation, and especially to our Wish Coordinators, Lindsay and Karin. We are grateful to our Rare Disease Foundation family for thinking of us and nominating us. We are also so grateful to David Shiffman for being available for questions and interaction, especially at such a busy time in his life. We were so lucky to meet the amazing scientists from the SRC lab on our boat trip; Leila, Julia (go Canada!), Natasha (viva Brasil!), Emily, Jake, Tim, Kevin and Jeff. And of course, the amazing Captain Eric and first mate Nick who took care of us on the water.

We were told from the beginning, that there was a chance they might not catch any sharks. It doesn't happen often, but it can happen - people can't control nature. We were unbelievably lucky on our Wish day with the number and variety of sharks caught. But what really made the day were the people, all the people, that came together to see Zach's "Wish Fulfilled", thank you all.

Pics by Jeff Palumbo - sharktagging.com

A Personal Orchestra - beautiful music or discordant noise?

I stand in front of a virtual orchestra. My musicians are doctors, nurses, occupational therapists, paediatric dentists, physiotherapists, office assistants, booking clerks, and health technicians.  The orchestra has also included Speech and Language Pathologists, a variety of specialty teachers, classroom teachers, Infant Development specialists, and researchers. Each section of my orchestra has had turnover, with new members replacing old, new kinds of specialists coming in and leaving, but always an echo of their presence remains.

In the meantime, I am meant to conduct these musicians. Their instruments are their tests, their knowledge, their hands, their work. The scores they play from are their reports, the test result placed in front of them. Each of them are sitting there, on their own, quite often sublimely unaware that they are but a small part of a greater musical endeavour. I try to weave meaning and music from their parts into the greater whole that is my son’s life – taking what I can from each appointment, meeting, therapy, and class. I interpret what I learn in one area and adapt, explain as I move on to the next musician. Always hoping that I can communicate for them. Always hoping that as a conduit I’m doing enough.

Wonderfully, amazingly, some try to hear the music coming from their neighbours to make sense of it together. Others just keep playing as if they are soloists, a Diva come to the concert to play at centre stage.

And there I am, madly waving my arms, my virtual baton whirling, whirling, trying to pull the pieces together. Conducting them as if they are my orchestra, yet their music, the scores from which they read are often a mystery to me. I ask them to share with me and some do happily, willingly: Others begrudgingly and some, not at all.

And still my baton twirls, and whirls, because there isn’t anyone else to try to make this orchestra work. And my son deserves that we find a way to make some beautiful music out of this cacophony of sound. 

Pulling this orchestra together is my job. But it could be made so much easier if information sharing was facilitated through an accessible health record. A common musical score, if you will. If there was a shared recognition that a patient with complex medical needs lives a complicated life – and scheduling that life requires respect and empathy. For the sake of argument, the recognition that everyone is a part of a larger team (or orchestra) that involves those in and out of the health care environment. Finally, I know that no-one will ever advocate for our son as much as much as my husband and I do, but the expectation that we are the sole information conduit through the health care system is ridiculous. This should not be how we optimise health care for those most vulnerable and compromised.

We can make better music than this.

My plea to the attendees of the #hcsmca National Symposium: Patients are more than our stories

#PatientsIncluded – Once more with feeling…

I am more than my story. This is something that I know and the strength of my participation in #PatientsIncluded conferences. However, too often, when patients and caregivers are included in conferences, they are pigeon-holed into the touching or moving portion of a panel that is meant to illustrate ‘why we are all here’.

#PatientsIncluded moves the needle so that real dialogue can happen. By ensuring the participation of patient voice from the planning stages, to having multiple voices throughout conference sessions, interaction between patients, providers and researchers can be fostered. Suddenly, patients or caregivers are more than their stories, we are thoughtful members of the healthcare system, or research team. We provide perspectives that bring insight to areas that were previously obscured.

To me this is beauty.

My Patient Voice in planning required some patience...

The #hcsmca National Symposium gave me my first opportunity to be on the organizer side of a conference, instead of just on the presenter/participant side. For me this was a welcome opportunity but it did present some challenges that I didn’t anticipate.

Driving change is hard. Our scholarship opportunities for patients and caregivers depended on sponsors also embracing the #PatientsIncluded philosophy. We had some great sponsors who saw the benefit of coming on board, but this concept of partnership and engagement will require more conference sponsors to embrace the importance of engaging the patient and caregiver participant – and backing it with sponsorship dollars.

Between you and me – I am often not always the most reliable committee member. I want to be, but our changing healthcare challenges mean that their demands can be urgent and erratic. My meeting attendance can suffer from last minute cancellations and getting my input and participation requires more work than is usual. I was initially worried this would mean that the patient perspective would be missed in the planning stages. However, it became clear that the rest of the #hcsmca planning team valued the concept of #PatientsIncluded as much as I did and accommodations were made to seek out my opinions even when healthcare had to become a priority.

Could we have done better? I believe so. It was a lot of pressure on me to be the sole patient voice on the organizing committee. I was honoured to be that voice, but I underestimated the competing pressures of my home life and wanting to do a stand up job in representing the patient community. While this committee was amazing at making sure that there were ways for me to contribute despite my constraints, I’m not sure every committee would do the same. In the future, my suggestion would be to have 2 patient reps on any #PatientsIncluded organizing committee. Life is simply too erratic and one healthcare crisis can take representation down to zero all too easily. 

#hcsmca Symposium – How #PatientsIncluded influenced outcomes…

 

When all was said and done, we had 12 self-identified patient/caregiver attendees at the 1-day #hcsmca National Symposium. It was a room filled with communicators, administrators, physicians, nurses, social workers, and researchers. And I’m probably missing some other categories of attendees. I’m sure that many (most?) of them had never interacted with patient advocates in a conference or problem solving context before, so I was very curious to see how it was going to go. Because as I said, we are so much more than our stories. We can start with our stories. Our stories inform our experiences, but we were there for so much more than that.

So here is my take home… at the end of a very full day of day of talks, plenaries, and unconference problem-solving interactions, conference participants crowdsourced the top 10 system-busting ideas. Out of those top 10 ideas, 4 of them were centred on acknowledging the wisdom of patient caregiver knowledge (summarized beautifully by Colleen Young).

Let’s think about this for a moment. The vast majority conference attendees were not patient advocates. Yet 4 of 10 top 10 ideas were centred around patient advocacy key messages. Would this have happened without #PatientsIncluded patient voices? What if we had had more sponsorship to allow for even more patient voices and more interaction between patients and health care professionals?

I truly believe beauty lies in the interaction between and within those places that were separate before – new ideas, new perspective, perhaps even fresh understanding. Healthcare need so much more of this. And not just at conferences.

So this is my plea to the 170 or so attendees of the #hcsmca National Symposium…

• Please, please, remember what we did there.
• Remember the beauty of including everyone’s perspective and take it beyond the #hcsmca conference experience.
• Don’t ever assume you know what the patient or caregiver knows or wants or experiences. We are here for the asking. So ask.
• Whenever you’re talking about patients, make sure you’re talking with patients. Take the principles of #PatientsIncluded and include us in an authentic way. This is the path to better healthcare.
• We are so much more than our stories.

And take to heart the number one rated idea that came out the #hcsmca Symposium and ‘Proceed Until Apprehended’. We’ll be right there with you. Beside you.

Photo by Mike Savage/21 Stops

Why the #hcsmca Symposium is Patients Included

This post was originally posted on Colleen Young's blog on January 29 2016.
 
For me, being involved in #hcsmca exposes me to an incredible diversity of voices. These voices include patients, caregivers, healthcare providers, researchers and healthcare communicators, and others who can’t be easily pigeon-holed into clear categories.
Weekly conversations punctuated by commentary throughout the week has allowed me to make connections, some of them very strong, with people that I simply would never have gotten to know. What’s more, I believe that we have all been able to expand each other’s view of the realities of our healthcare system, providing care and living with health conditions. Social media let us speak to each other plainly, concisely and connect meaningfully. It doesn’t matter that you are at work, taking a break between patients or clients and that I am at home looking after my son wondering when I will hear from one of his health care providers next. We are all, together, having a conversation about the meaning of better health care and community; titles, jobs, heck, time of day, fall by the wayside.
However, in the world of conferences and in person events, it’s tougher. For too long those health care conversations have been held about patients but not with patients. To be frank, if we are going to get to the solutions that work best to improve health care, we can’t afford to not to include the voices of patients and caregivers. We hold a wealth of knowledge and experience that we want to offer, and we don’t want to be kept outside closed doors.  
Even with the best of intentions, it can be difficult for conference organizers to make their events inclusive of patients and caregivers. It takes more than just saying, “hey everyone, come on in.” Patients and caregivers face real and systemic barriers to attending medical conferences, not just cultural ones.
Recognizing these barriers, the Patients Included charter was created to help conference organizers structure their events to welcome and integrate patients and caregivers from planning, to speaking and attending. The Patients Included charter outlines 5 clauses facilitating authentic patient participation – patient participation that is meaningful and will make the conference better for all participants.

The 5 charter clauses are the starting point to get patients in the door. And I say starting point because I think that once conference organizers start including patients, they’ll recognize the value and grow that inclusion in subsequent years.
Deciding to take the online #hcsmca model offline to a National #hcsmca Symposium is incredibly exciting. And we made sure we met all 5 clauses:

1. I, as a caregiver, am a member of the Symposium Planning Committee. Patients reviewed the scholarship applications. The event is an unconference. All attendees are involved in the planning and design. 
2. Patients and caregivers are attending, speaking and leading sessions at the symposium.
3. Scholarships were awarded to 2 patients, 2 caregivers and 2 students. Travel and accommodations have been arranged and paid for. With additional sponsorship, we will add more scholarships.
4. Accommodations will be made where necessary.
5. The main stage will be livestreamed. Virtual participants can also follow #hcsmca. Notes and pictures from the break-out session will be open-access.

For the #hcsmca community, Patients Included recognizes what we already know – patients and caregivers are valuable contributors to our diverse community. Sure, those that attend benefit, but really, the whole community benefits from their inclusion. Even if I, as a caregiver, say so myself.
Don’t miss this event.