A $50 million question

Re: "TMI? Not in Today's Health Care World," by Bill Santamour, July H&HN

I work in a midsize hospital and daily work through several of your topics: data, IT, clinical outcomes and … oh, yes, communication! I was at "teaching rounds" with surgeons and residents and after a review of a difficult case; the topic was ... yes, you guessed it, the lack of communication or, perhaps, a delay in care related to ineffective communication.
In a society where we are rushing around trying to accomplish seven things at once and see several patients in the course of a day, the outside world is telling us to increase our face time with patients to drive down miscommunication and readmissions and increase our HCAHP scores and revenue. Some of my colleagues would look at me and shake their heads. OK, when?

Now there is the $50 million question. But, with perseverance and teamwork, and, here it comes again … clear, understanding communication and patience, I believe we can do this. Actually, we have to. These topics are front and center. They aren't going away. Real dollars are and will be attached to them.

Funny, back 15 years ago, the health care scene was very segmented. Docs cared for patients, nurses took orders and provided bedside care, and the quality department was out there somewhere. Now, care is driven through quality, outcomes and evidence-based practice. Don't get me wrong, this is important due to the changing landscape of health care. We all need to be in the same "silo," not separate ones.

Patients need to become tech savvy. Saving personal health information, having it accessible in case you find yourself in the ER with a physician who doesn't know you from Adam. You may be going, "TMI." Part of the solution is to be specific about your personal health records.

Lynne Wolfe R.N., B.S., ONC
Crouse Hospital, Syracuse, N.Y.

Chaplains: Communication experts

Re: "So Quit, Already: Futility, Faith, Family and the Ongoing Battle Over End-of-Life Care" by Emily Friedman in H&HN Daily, Aug. 6.

One thing that is within health care but often overlooked is the contribution of professional chaplains. No, we aren't there to push religion on people; we're the experts in communication and assisting in identifying patient beliefs and values so that they can be communicated to and integrated into their medical plan of care. We work with distressed families to improve communication both within the family and the care team. We are members of the interdisciplinary team, including palliative care teams. We identify cultural issues as well as religious ones that may be either barriers or support. We do understand advance directives and educate patients about completing them and families about honoring them. And we do communicate well with physicians when the times happen — and they do — when doctors don't pay attention to the patient wishes. Illness and end of life do encompass deeply held beliefs and values — whether religious, spiritual or cultural — and those need to be identified and incorporated into the plan of care so these issues can be addressed earlier. Chaplains are essential to this hope for integrative care.

— Sue Wintz

A skewed perspective

Re: "Soda or No Soda, Diabetes Is on the Rise," by Matthew Weinstock in H&HN Daily, Aug. 2

The adage goes, "where you stand depends on where you sit", so it is not surprising that H&HN looks at diabetes narrowly as a disease and, therefore, opposes measures like Mayor Bloomberg's to address one of its root causes. As long as the American health system's business model is rooted in more treatment and not prevention, preventable conditions like diabetes will be viewed through a service provision and revenue generation lens while health care costs rise and health status measures slide.

— Patrick Lenihan

Hope for humans

Re: "Goodbye, Cruel World; Hello, Humankindness" by Bill Santamour in H&HN Daily, Aug. 6

I figure if we evolved opposing thumbs, then humans will eventually evolve more collaborative behaviors. Thank you for the evidence that it may be happening more quickly than I thought!

— Annette Simmons