It's not what you are eating, it's what's eating you…

Archive for the ‘#MDPTSD’ Category

An Open Letter to #HennepinHealthcare’s Emergency Department’s physicians…

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Dear Dr. S and Dr. C (purposely not using last names, for physician’s right to safety and anonymity),

I was in your Emergency Department on 1/15/2019, in the morning around 8 a.m.

I understand as I presented as a very unkempt but for the most part, polite 49 year old obese tobacco using patient complaining about a bad cough, but more concerned about the severe left flank pain that occurred every time I coughed or sneezed that a pulmonary issue might take precedence over a digestive one.

I stopped being quite as polite when I checked my tests online and found after almost 3 hours of being there that I only had a urine analysis and pregnancy test, that was run.

I could understand with your facility being a level 1 trauma center that you may not have had time to read my chart, which doesn’t contain much, as I’m a Fairview patient.

Even though I did have a bilateral salpingectomy with endometrial abalation and d/c at your hospital, over 5 years ago and that my chart while not up to date with diagnoses, is update to with medications I am on, which gives an idea of my health issues.

However, while you got Lisa the vulnerable patient yesterday, you’re getting Lisa the activist today, in hopes it helps with others like me, who honestly thought they had an acute health issue and was NOT drug seeking.

This is what I can’t understand and is unacceptable to me, and when things are that way, I try to say something, make it a teaching moment, regardless of the socio-economics, education and profession of those who’s biases effect how I and others, get treated.

NOT every patient who goes through your ED, is looking for opiates, some of us patients who are obese to morbidly obese, have done everything under the sun, to lose weight (hence my side gig as an activist, like one of 3 GLOBALLY, who helps people in medical and mental health trauma with serious gastric bypass complications, on the scale that I do, as well as other medical and mental health activism that I do).

My visit yesterday at Hennepin Healthcare’s Emergency Department, wasted time and money.

It caused me unnecessary duress, because you have patients with barriers that have a propensity to possibly be violent, which caused enormous anxiety.

But the worst duress I experienced, was the assumptions and absolutely NO questions asked about certain things by physicians, that could’ve made my visit a lot more pleasant.

I did see, after I pushed for a blood work up, that were ordered FOUR hours in to my visit, my labs were good.

I also saw today, that I was prescribed a script that was ordered and filled at your pharmacy of high strength ibuprofen when I have a bleeding ulcer history and NSAIDS are an absolute terrible treatment option for pain for me ( and again, I did NOT ask for ANY medications, nor will I get or take script).

Unfortunately, when the IV came out, my vein spurted which wrecked my discharge paperwork and the pants I was wearing and all over my hands and some of the staff was ready to send me home with no help, until another set of staff saw that I was tired and shaky and helped me and I was appreciative of their help.

For quiet non violent introverts, your Emergency Room department is a terrifying place to be.

As I’m sure it is for a lot of people, introverted or not.

For those of us who’ve been labeled  due to mental health issues, it’s even more amplified, with anxiety caused by patients who are violent and fear of medical professionals who’ve labeled me, in the last 17 years, not just for mental health issues, but because I had bariatric surgery.

And while some staff was great at the hospital, what will leave a last impression from what will be my last visit to your facility, is that a busy physicians didn’t take the time to ask me anything, either assuming I didn’t know or wouldn’t be truthful and while you were nice, once I said something about being upset about that, that’s NOT okay.

So please, for the mental wellbeing of your future patients, if they are ambulatory, alert, articulate and polite, don’t label or practice medicine with preconceived notions about a  patient.

Actually, just DO NOT  practice medicine with any preconceived notions about a patient, like EVER.

As in my case, I loathe seeking medical attention and my visit from yesterday made it that much harder, way harder than it should’ve had to be.

As well as it made it more difficult for yourselves, and I have the utmost respect for physicians (as well nurses and all other hospital staff)  of any specialty, but especially for those who work tirelessly and usually without thanks, in an Emergency Room.

So thank you for your time yesterday and today, and hopefully going forward this will help both patients and physicians in your hospital, going forward.

Respectfully, Alissa “Lisa” Kasen

Update: 1/17/2019, when I wrote this yesterday, I tweeted it to Hennepin Healthcare and to my delight, they actually tracked me down and called me, today,  to address my concerns, which is much appreciated.

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Physicians with biases ARE physicians who HARM, even if it’s unintentional…

 

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Disclaimers: I am NOT a clinically trained or credentialed medical or mental health professional. NOTHING I say should EVER be taken in lieu of professional medical and/or mental health evaluation or treatment of ANY condition.

I can ONLY put my opinions, where I hope to help people, where I have in guiding them, at the very best, simultaneously,  at the same time to get the best medical or mental health treatment, from trained clinical professionals, in an appropriate setting , such as what I do with gastric bypass patients in various scenarios with gastric bypass reversals, among other things.

BUT,  what I have to say about how various biases carried by physicians and the potential for physical and emotional harm, still needs further civil, respectful and responsible but sometimes when appropriate, critical discussion, not ONLY by patients but the actual medical and mental health professionals within their own  communities.

I ONLY believe though, when dealing with a provider who one might feel is showing bias that effects one’s care,  of discussion of potential  misbehavior, if  one feels that they’re being treated unfairly or unreasonably, because of that bias (I’m talking about appointments, not to the point where blatant physical or emotional malpractices have occurred) of filing a grievance, if a discussion doesn’t resolve the issue and/or finding another physician.

It is NEVER okay to threaten the emotional or physical wellbeing of anyone, including a physician or any provider, for biases and if depending on the degree of physical and/or emotional harm has occurred, if that’s an actual issue, there’s legal remedies one can look into and/or take.

That’s it, making or threatening a physician’s physical and emotional safety and wellbeing is NEVER okay (more will be elaborated about that, in the content of this blog).

Also note, I have people I associate with where they may find my communication style at best, offensive, because I’m kind of open with my various disabilities and with those disabilities, it’s difficult for me to be concise or write well, even if this topic definitely needs discussion and resolutions.

***

All I wanted to do last weekend,  was to  have an okay weekend.

Let me explain, as most people know, that due to my disabilities, that I don’t have anything normal in responsibilities, like people my age do.

But in my case, I kind of dread weekends, while my blogs have been both personally and as an activist, VERY serious as of late, it’s kind of scary where I live, because on weekends, when staff isn’t here, people are more likely to act out.

Even with cameras, unannounced drug sniffing K9s and security during nights and weekends.

While I explain to those few about explaining where I live,  that 1/2 the building where I live are good to have as neighbors, the other half is people who have issues with drug addiction and what it takes to support an illegal drug addiction (dealing and/or other illegal and unsafe behaviors to support an addiction of themselves and who they associate with) , if one’s on their way or headed to rock bottom, especially for poor people, it’s not a fun thing to live amongst, even if I have some empathy for non violent addicts.

The best way I can describe where I live is my building is like a stupid drug cartel that’s badly managed and a church had a baby.

Seriously and it’s NOT funny or fun to live in, even though I’m grateful for my housing.

Also as a serious activist, if I’m going to point out where doctors fail patients in under medicating patients or being afraid to use opiates as a last resort, I also have a responsibility as an activist, to do no harm, myself.

To either patients or providers or to anyone.

The last thing I’d want to give the impression, as an activist,  is that people can be complacent nor would I want to enable, when it comes to the potential of drug addiction or feed into a denial pattern, if they actually are in the midst of drug addiction or heading into drug addiction with either prescription or  illegal opiates.

I know it sounds like I’m digressing, please be patient, I will make my point when it comes to physicians and their biases and how it harms.

Because of all the clinical data I have to read, both as a patient and as an activist, who’s trying to find answers both to opiate addictions and obesity surgery complications, is by using Google.

So when last Saturday night,  it was in my suggestions on Google,  to check out a physician driven site to support and educate medical providers, especially as it applies to interventional pain management or obesity related issues (among many other medical topics but those were the 2 most talked about ones, as well as ones I’ve discussed ad nauseum in this blog in the past) , I didn’t need that site, to know that bias among physicians was horrifyingly pervasive and permanenting who apparently were WAY unaware that they had a few of these awful biases that I’m going to discuss in this blog.

I just didn’t need to see it on Saturday night, when my building was a hotbed of not life threatening criminal behavior due to drugs, but it still was scary because you don’t ever know when that’s going to escalate.

I happen on that physician site to read an article a blog that  a pain management specialist wrote,  who was trying to make a point on how tricky it is to do pain management using a popular stereotype that’s perpetuated not only with non physicians, but within the medical community.

Patient #1:  was a morbidly obese patient who misused opiates claiming she was under medicated, that she was treating who had  needed a double knee replacement and severe  back pain  due to a disc issue (and apparently her inability to stop eating for more than a minute)  and had mental health issues and when the physician pulled her meds due to her non compliance and her quite clearly expressing the patient having NO willpower whatsoever, that patient trashed her online, so she thought, as right after that happened, she received a bunch of negative reviews on a bunch of medical websites.

Patient #2: Very friendly thin patient perfectly compliant dying of cancer, who used a moderate amount of opiates sparingly, despite her severe intractable pain due to terminal cancer with mets and in this instance, the pain management doctor had a nauseating borderline reverence, for.

I will admit, that I’ve had that kind of prejudice similar to patient #1 even though I’m not known for compliance with most meds, other than narcs due to high tolerance (and how I’m resolving that, will be in another blog, soon).

But that blog by that pain management doctor, hit me way harder as an ACTIVIST.

This is what I know to be true, due to the  activism that I do.

Bias can kill patients not only from physicians even if it’s not intentional, due to stigma, as well as by,  non physician peers.

I get that all the time, when I have to talk to a gastric bypass patient with catastrophic complications, into what may be right for them, such as a a gastric bypass reversal, who’s going to die, has a BMI of 19, even with weight loss of 200 lbs and NO surgery to correct extra skin, so their BMI is actually even lower, when that’s taken into consideration, but they’re afraid of and what’s worse, is their current bariatric surgeon is afraid of doing a reversal, in case they become morbidly obese, again.

Where they are more likely to DIE from their catastrophic complications, before Obesity again could put them in mortal danger.

Or in the case because I’m a body diversity activist and find thin shaming repugnant, if I say that someone who’s thin, they’ll usually share their skinny shaming stories and if they’ve had a past or current history with bulimia and/or anorexia.

Or when I see within the weight loss surgery community, patients who get very thin because they’re terrified they’ll be fat again, not realizing that it’s not ideal, it’s actually unhealthy,  to be exercising intensely like an athlete, on 400-1000 calories a day, not only does that make them more at risk for exercise related injuries, it kills their metabolisms, in the long run, if not creates other health risks.

So doing behaving that way is no insurance policy that a bariatric patient won’t gain weight again or have any other severe health problems.

Or if they have bariatric surgical complications, quite a few bariatric patients actually think they deserved them, because they were fat in the first place and had to resort to bariatric surgery.

Or when patients who are morbidly obese to medical and mental health issues and want bariatric surgery or to lose weight, they sometimes become obese due to inactivity due to their health issues and their medications, they can’t have their total knees without losing weight or their bariatric surgeries and they can’t lose weight without either surgeries and are absolutely in a no win situation.

With weight stigma, especially when it comes to Obesity, it hurts both fat and thin patients.

With fat patients, they hate getting medical care, because if they go the doctor for strep, it’s going to be blamed on their weight.

And it shouldn’t be any surprise but it will be to providers, if they have fat bias, the patients who they are treating are FULLY aware of that and that’s why people of weight loathe to seek medical treatment which can sometimes kill a patient, but even at unfortunately, at best,  unnecessarily makes getting any kind of medical treatment, a lot harder than it should be.

It also hurts and potentially harm  thin patients, because they may less likely to think they could have health issues, and their physicians feel the same way, because if they’re a “healthy” weight, it’s presumed, that they’re actually healthy,  when they may not be.

With opiates due to stigma, if a physician has a patient who’s in intractable severe pain, there is a risk they will self medicate and possibly harm if not accidently kill themselves,  they engage in unsafe and unhealthy behaviors to treat their pain and/or they kill themselves, if they aren’t appropriately medicated and/or suddenly taken off their medication.

Especially now, with the opiate epidemic, patients who are compliant, but have been on opiates for a long time are now starting to die, because they find a dealer and/or patients are actually commiting suicide, becoming collateral damage because of the opiate epidemic,  due to unbearable physical pain, because they don’t feel they have any other options and they have no quality of life and they have no options as a last resort for pain.

Absolutely NO physician should be congratulating themselves or encouraging as a positive behavior,  that a terminal patient has great “willpower” by not using opiates for severe intractable pain, if medications are working properly, when the risk of addiction in that patient is next to nothing and the patient is ONLY afraid to take opioids, because of stigma due to drugs, and would rather die a horrifyingly  painful death than be considered a drug addict due to stigma , even if the patient is going to DIE.

NONE OF THIS IS OKAY!!!

I’ve said this before, as a medical activist.

HOW and WHY, in this evolved technological era, why are people becoming MORE backwards in our society, has to be discussed openly, without stigma.

BUT medical and mental health professionals take an oath to try and not do harm.

IF they have personal biases, regarding fat patients, challenging patients to treat or mental health patients and/or any other kind of  biases, who are coming to them for any kind of treatment, they OWE it to their patients, to give them the best possible care.

And they can’t do that, if they have ANY kind of  preconceived particular bias towards ANY population of people.

In the defense of physicians or any medical or mental health provider, while I’m not excusing bias that limits their ability to care for their patients, they shouldn’t have to worry about physical or emotional harm, either.

Also patients LIE, like all the time or don’t even realize the dangers if they are aren’t lying a lot, but about things that may seem trivial to them but it’s not and it makes them a liability to both themselves and possibly their providers, especially one who is prescribing narcotics to them.

But even if 9,999 out of 10,000 patients are lying, especially about what they’re actually ingesting, all of them deserve to be given the benefit of the doubt, especially if the 10,000th patient may be, if not, is actually telling the truth

Every patient deserves an individual patient tailored approach to their unique physical makeup being able to feel safe with their medical and mental health providers.

Every provider should feel that they don’t have to worry about being physically or emotionally harmed, because they say something or take a course of an action that a patient doesn’t agree with.

Patients should just stop seeing that provider in that case, in case of negligence or harm, consider a legal remedy, that’s it, if a reasonable (as patients can be respectful, responsible and critical at the same time) discussion or resolution is NOT possible with a provider and/or seek a different provider, if possible

But pretending that bias doesn’t exist, that it can harm patients in their ability to get appropriate (and sometimes lifesaving) treatment of their health conditions,  that resolving one addiction and not addressing the nature of addiction, can lead to another, is harming people, both patients and providers, alike.

Because we aren’t having the responsible and respectful dialogues we need to, as as society,  because of STIGMA.

So while I will hold a physician to the hippocratic oath, it couldn’t hurt anyone, if we actually all took it.

Note: Constructive feedback, only.

Also note: Again, I believe in both any of the obesity surgeries AND opiates, as an absolute last resort. I’m not against any weight loss surgery, I just have a unique situation in being one of the more long term gastric bypass reversal patients out there, of being asked about that, a lot.

As it applies to opiates, I have lost people I’ve cared about due opioid addiction as well as see it in other case, such as described above, ruin people’s lives, so again, it bears repeating, I’m not trying to feed into or enable the opioid epidemic, as an activist.

Although, I’m also not going to apologize for being supportive of invasive medical treatments for different health issues, i.e. both obesity surgeries and opiates, but I will always strongly urge people when you take drastic action, make sure you have a long term plan, are well educated and are well supervised, medically (and mentally), life long.

Nor am I going to apologize for the length of this blog, due to the sensitive nature of what I addressed in this blog,  that I had to so  comprehensively and fairly, to do  justice both to patients and providers, alike.

And if you saw at times, what frightening words or phrases sometimes end up in search engines for my blog, well you’d understand better, why I have to have such a lengthy in depth disclaimer.

Thanks!!!

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