Population Health and the Aging

Re: "IHI Wrap-up: Berwick Returns; the Power of Patients" by Haydn Bush, H&HN Daily, Dec. 8

A patient-centric health care system will be difficult in the face of an aging population presenting with multiple comorbidities and lack of family support. I see a lot of patients well in their 60s burdened with CAD, CKD, T2 DM, HTN, unable to cope or manage their medical regimen. I ran a CAPD program — it takes commitment from both patients and providers to achieve desired outcomes. What happens to patients in their 80s and 90s who lack financial resources to maintain caregivers?

This system works best in certain demographics: population in their 40s to 70s, good amount of education, skills (dexterity, adl/iadl independence), good understanding of all their disease processes, and compliance with prescribed/recommended regimens, and time and money to do and afford such regimens.

—Teresita Avecilla

'Call to Action' on Disparities

Re: "Who We Are: Implications of the U.S. Census for Health Care, Part 2" by Emily Friedman, H&HN Daily, Dec. 6

I am so thrilled to see this issue being addressed by this publication. Your article is a comprehensive "call to action" that I hope provides the necessary "nudge" to act that many hospitals need. I had the fortune to spend 12 years at the Joint Commission, the last eight focusing on understanding and addressing health disparities. The work resulted in recently adopted accreditation standards, but it wasn't easy; there is a lack of admission that focused attention is needed.

Thank you for recognizing how truly important it is from an administrative and quality perspective ... and also for sharing how enjoyable the journey can be.

—Amy Wilson-Stronks

Telling Patients Who's Operating

Re: "Informing Patients About Residents' Role," a podcast by Rick Hill for H&HN Daily, Dec. 5

I find it hard to believe this requirement is necessary or that it would change what is being done! When I trained and when, much later, I became a thoracic surgery program director, we always informed the patient of the resident/fellow's role in the operation.

I recall one patient who had some concern about our fellow doing his first start-to-finish open heart operation on him. I explained to the patient how the fellow had performed all parts of the operation very well, multiple times. This was just the first time we were going to let him do the operation from start to finish.

I further explained how I was going to be there to assist and that I could take over from the assistant's side of the table at any time if I needed to. The patient thought it over and agreed to let the fellow do the operation.

I had a patient who did not allow me to do a hernia repair when I was a resident because of his religion and my gender. No problem, his choice.


Stressed-Out Clinicians

Re: "When Blunt Words Are the Kindest Kind of Care" by Bill Santamour, H&HN Daily, Nov. 29

Having been a patient through cancer surgery, staph infections, and two hip surgeries, I can say that few times did I receive "care" that was too warm and fuzzy. In my opinion, the problem in health care in the U.S. is on the other end of the spectrum — clinicians who are so stressed and frustrated with the "system" that they lack the kind of care that could really help patients heal.

Care to me isn't about being warm and fuzzy at all. Indeed, some of the clinicians who were most caring to me were crisp and professional to a fault.

But I wouldn't worry that somehow clinicians will get too warm and fuzzy. It's the stress clinicians carry into the room of the next patient [that] is the bigger concern to me. We need to help them truly care for themselves and then the care they provide will be enhanced.

—Bruce Cryer

Elderly Schmederly

Re: "Is 90 the New 85?" by Bill Santamour, H&HN Daily, Dec. 5

OK, so now we know who the "young elderly" and the "old elderly" are. So what are the 70- to 85-year-old folks called? Besides I am not "elderly," I am just chronically advanced!