DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES

I recently had the initial physical exam for Medicare. My doctor asked me if I had a physician's directive to add to my file, and I told him it was in progress. Today it is finished, along with a will, medical power of attorney and durable power of attorney. The doctor commented that I was the first person who had ever  said that these documents were in the works, much less that they were complete. Boomers, do you think you will live forever?

Do all the baby boomers get one of these?

I received this by snail mail yesterday. It is the first mail solicitation I have ever received from a Canadian pharmacy. Are all the baby boomers out there getting one of these when they qualify for Medicare?

I won't be buying from Global Pharmacy Canada, I'm just curious. My sister was the only person I have known personally who has used Canadian pharmacies, and she was pleased with price and quality. This was several years ago, however. Anybody have any more recent experience that they are willing to share?

I was my father's guardian for the last few years of his life, and so I was interested in my sister's experience, but I didn't purchase anything for him. Anybody willing to share their experiences with Canadian pharmacies as part of their care for their older family members?

Hospital-Acquired Infections

 During a recent hospital visit, a MD making his rounds performed a brief patient examination in my presence. He introduced himself to me, we shook hands, he performed his exam and shook hands with both of us before departing the room. At no time did he wash his hands. Nurses were the subjects of my previous blogs with this same title, but I had already read complaints from other staff about doctors who don't follow hand washing procedures. Since doctors give nurses and other clinicians orders that they are supposed to follow, this creates an awkward situation.

GE has produced the graphic below, with supporting details here.

GE produced this graphic in support of their Healthymagination program, which includes the Smart Patient Room. Their press release at the May 2011 first anniversary of the program reports $700 million spent on R&D thus far, so Jack Welch's hospital-acquired infection has had quite an impact. Doctors and even visitors are not allowed to exempt themselves from hospital hand washing procedures when the Smart Patient Room technology is present. There are relatively low-tech solutions which have produced a decent level of compliance, e.g., the Targeted Solutions Tool, but I favor the medical error reporting system that is part of the Smart Patient Room technology.

From the above graphic, you can see why Medicare/Medicaid is proposing that hospitals and clinicians not be reimbursed for HAIs. The savings to the programs would be significant. Also, this is part of the push for electronic medical records, with electronic entries made in a patient's records for the sake of prevention of many sources of errors, e.g., patient identification, administration of the correct drug in the correct amount and at the correct time, confirmation that all surgical tools and sponges have been removed from a patient before suturing, etc.

The figure below from Infection Control and Hospital Epidemiology 32(4):388, 2011 (pdf). is cited as an indication of what is probably happening now. Since this and other studies are retrospective based on laboratory and patient discharge data, current national numbers await definitions for HAIs and standardized laboratory testing.

The five year trend for ten hospitals in the Duke Infection Control Network indicates that the incidence of Clostridium difficile has surpassed methicillin-resistant Staphylococcus aureus because the incidence of the latter has been dropping. The efforts made for MRSA control now need to be extended to C. difficile.