Monthly Archives: July 2018

How Essential Is Doctor-Patient Communication To Whole Health?

Posted on by

Nurse-Patient Communication

At the National Health Policy Conference held in Washington, D.C., members of the Agency for Healthcare Research and Policy agreed that the need for research focusing on the doctor-patient relationship was urgent in order to address the current crisis of patient dissatisfaction, medical-error, malpractice claims and physician burnout. Communication between the patient and all practitioners or  caregivers is thus an essential component of any whole health approach.

Patients are not happy, doctors and medical teams are not happy, and the health care system is struggling to adapt measures to turn the tide of this growing problem. The 2012 Institute for HealthCare Communication (IHC) report regarding research on the impact of poor communication revealed the following:

  • Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period.
  • This means that when healthcare team members do not communicate effectively, patient care often suffers.
  • Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively.

The research from the IHC reports cites that 50% of all malpractice is the result of poor communication between doctor and patient.

The IHC report states: “Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.”

IHC goes on to make an alarming statement that “Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help.”

And, while the addition of nurse health coaches to the medical team has been viewed by some as a solution to the communication problem, the relationship between the physician or primary care provider and the patient cannot be corrected by these additional team members. In fact, not addressing the underlying cause of doctor-patient discomfort may even increase the distrust and discomfort the patient experiences with their doctor or primary care provider.

As physicians, physician assistants and nurse practitioners are the diagnostic experts in our medical care system, ensuring the communication between these providers and their patients is critical, as research data demonstrates.

A recent pilot study, conducted through Central Michigan University (CMU), on the effects of a communication model, Behavior Engagement with Pure Presence, on patient and physician satisfaction has just concluded, and will be published shortly. The study was funded by Blue Cross and Blue Shield Foundation of Michigan.

The Primary Investigator (P.I.) of this study, Dr. Christine Clipper, wanted to thoroughly test the Behavioral Engagement model by including renowned endocrinologist, Dr. Opada Alzohaili, who was trained in the model’s communication skills and had previously earned high patient satisfaction survey ratings. Dr. Alzohaili’s post-pilot patient satisfaction scores were significant, revealing 100% improvement on all measures of patient perception of relational empathy during their encounter with the doctor, in contrast to his pre-pilot patient satisfaction scores.

Dr. Clipper’s research data demonstrated that Behavioral Engagement with Pure Presence has “…a psychological effect on the patient’s perception of the patient-provider relationship. The patient perception of relational empathy with their doctor increased through improved provider communication skills through applying the Behavioral Engagement model.”

Further research on the application of the model includes a pilot study on the Behavioral Engagement model in Electronic Medical Record Communication, funded by the U.S. Department of Health and Human Services/ MI Dept. of Community Health;
and a randomized controlled clinical trial study with funding from major national health care organizations.

For more whole health discussions like this, listen to Dr. Georgianna Donadio’s radio show Living Above The Drama.

 

The Mediterranean Diet Is About More Than Just Food

Posted on by

mediteranean diet, niwh, whole health

In Annia Ciezaldo’s April 1st article in the “New York Times Magazine,” she asks, “Does the Mediterranean Diet even exist?“ She suggests that since half of Spain, Portugal and Italy’s populations are overweight — with Lebanon rapidly following suit — then, contrary to popular belief, the Mediterranean people now have the worst diets in Europe.

She states that the Greeks “are the fattest: about 75 percent of the Greek population is overweight.” From Ciezaldo’s perspective, the Mediterranean Diet research, which spanned over 50 years, was in fact — flawed.

Research on the whole health benefits of the Mediterranean Diet has been well-documented and includes the Harvard School of Public Health and many esteemed medical researchers. Among them are Ancel Keys and Paul Dudley White, who later became Dwight D. Eisenhower’s cardiologist.

Shortly after World War II, Keys and his colleagues set out to examine whether or not the Mediterranean dietary and lifestyle patterns were directly connected to improved health outcomes identified in Crete, Greece and southern Italy during the 1960s. These outcomes recorded the lowest rates of chronic disease in the world, and the life expectancy of adults in these regions was among the highest. This was particularly remarkable given the limited amount of medical care and services that were available to this population and the poverty these regions experienced.

Keys then began the long running Seven Countries Study and monitored the lifestyle and dietary habits of 12,700 middle-aged men in the U.S., Finland, the Netherlands, and then Yugoslavia, Italy, Japan and Greece.When the data was examined, the people who were the healthiest ate a diet where fruits and vegetables, grains, beans and fish were the basis of daily meals and valued vigorous physical activity and high social interaction. At the top of the list were the residents of Crete.

Scientists have intensely studied the eating and lifestyle patterns characteristic of the Mediterranean Diet for more than half a century. And with dozens of research studies, the evidence is that this way of eating and living results in an across-the-board reduction of chronic disease and increased longevity.

This evidence confirmed that certain Mediterranean lifestyles and dietary patterns were connected with good health. As a result, in the 1990s, Old Ways, an internationally respected nonprofit organization, joined in partnership with the Harvard School of Public Health to provide global education and information on this important disease-preventing evidence.

What the article has apparently overlooked is that the Mediterranean Diet is not just about what people eat. It is about the values, habits, relationships, quality of how food is grown and the quantity of how food consumed by these particular groups — not just how or what they eat. A point that is often missed by the media is that health is not isolated to one’s diet. The whole health of an individual is about the physical, emotional, nutritional, environmental and even spiritual components that create our overall state of health. Our dietary choices and habits can be seen as a metaphor of what the overall or whole picture of that individual’s health is expressing. We eat how we think, feel, work and behave, all of which are influenced by our environment, values, age, financial and education levels and even by our gender.

Beyond just nutritional health, the Mediterranean Diet promotes a way of living that includes the following components, which could explain the positive health benefits.

Intense physical activity that includes work and all its forms of movement; farming, building, planting, gardening, dancing, sports, house work, child care or any activity that provides a non-sedentary daily routine.

Consuming many types and varieties of food in moderation as a form of nourishment — both physically and socially, as well as sharing with others.

  • Meals are a part of the social and family fabric and are not taken alone.
  • Time spent eating is relaxing, nourishing and pleasurable.
  • Foods choices often include fruits, vegetables, whole grain bread and other cereals, potatoes, beans, nuts and seeds.
  • Olive oil is an important monounsaturated fat source in the diet.
  • Dairy products, fish and poultry are consumed in low to modest amounts, and little red meat is eaten.
  • Eggs are consumed zero to four times a week.
  • Wine, a component of social family sharing and bonding, is a dietary staple this is consumed in low to moderate amounts.

Is it any surprise that Europeans, who now have McDonalds, Kentucky Fried Chicken, electronic messaging that is replacing relationships and high credit card debt (none of which were there when the Seven Countries Study began), are becoming as obese and unhealthy as Americans are?

What is missing from many “nutrition books of the week” is the organic, common sense understanding that the food we eat is just part of a multi-faceted set of choices we make in how we choose to live and behave. Many of these choices are based on our personal and collective social values.

I was recently asked, in a conversation with an advisor to the U.S. Surgeon General, what I thought was the solution to health care cost reduction. I stated and firmly believe that until we as a nation return to the values we embraced and lived by up until the mid-1980s, a time when the “The Lifestyles of The Rich and Famous“ became the national obsession, we will remain a nation of countless individuals who feel in many ways marginalized from contributing our skills and talents — who are hungry to be seen, heard and valued.

This lack of belonging leads to poor nutrition and behavior choices, which serve in our efforts to self-sooth and self-medicate, as the world we inhabit continues on its trajectory of financial and societal misdirection. Yes, the Mediterranean Diet does exist, but the values that make it a healthy way of life are rapidly fading.

For more whole health discussions like this, listen to my radio show Living Above The Drama.

Is Bisphenol A (BPA) Still Hiding in Your Food?

Posted on by

Most of us engaged in health professions are already aware that there are lots of dangerous materials like additives, dyes, pesticides and carcinogens in our foods. What many of us are not aware of is that in the containers that our foods come in, especially take out, there are chemicals in the materials that may be even more harmful than the additives, dyes and pesticides.

By now you have probably heard of the dangers of the toxic chemical Bisphenol A (BPA). This chemical can be found in polycarbonate plastic food containers, bottles and takeout food containers. Numerous articles have been written on breast cancer and prostate cancer that result from exposure to the BPA contained in packaging and containers that carry food stuffs.

Recent, important environmental health study findings pertinent to health coach certification were published in March in the online journal Environmental Health Perspectives. A study was conducted by two organizations concerned with the environmental causes of breast cancer, the Breast Cancer Fund and Silent Spring Institute. The study was on the dangers of BPA.

The organizations identified and followed five (5) families who frequently used packaged food and drinks which were made for microwave preparation. The BPA levels of these families, which both consisted of a mother, father and two children, were measured and recorded.

Then, these same families ate fresh, organic food cooked only in glass or stainless steel containers. The immediate results on the level of BPA in their bodies with  the packaged food and fresh food was measured via urine collection, at varied intervals of the testing.

The outcomes were significant with all participants having lowered BPA levels in 72 hour period after the BPA rich packaging was exchanged with glass and stainless steel containers. The average decrease in the BPA was approximately 60%.

The study demonstrated that as quickly as six (6) hours after exposure, half the BPA is eliminated through the urine. However, if the prior use of the BPA rich packaging is resumed, the BPA levels demonstrate a return to the pre-intervention level on urine analysis. When the families resumed their normal diets, their BPA levels returned to pre-intervention levels by the next urine sample.

What is important about this study is that it demonstrates that we can easily reduce the levels of BPA our bodies are exposed to by eliminating the use of the packaging it is found in and by cooking and preparing our foods more naturally. It is important not to use these BPA rich containers to microwave in as this increases the amount of BPA exposure.

Using glass or ceramic containers in the microwave is healthier and most importantly, they contain no BPA.  By also avoiding canned foods (unless the cans are BPA free) you will cut down on this dangerous exposure for both you and your family.

For more whole health discussions like this, listen to my radio show Living Above The Drama.

 

Going On Vacation? Protect Your Health

Posted on by

With rising temperatures and summer break in full force, a lot of people decide to take a vacation. This is a time when when millions of people “take to the skies and roads,” visiting friends and relatives or exploring new locations. It’s a time of fun and relaxation, but there’s a hidden danger you might not know about. Unfortunately, 3-5% those who get off of airplanes, buses, trains or auto transport will develop blood clots, often not detected until many weeks after their trip.

As American health care consumers, we know in today’s environment that we must be pro-active and take control of our health through education and prevention. Staying healthy while traveling is one very important preventative situation that we can all be more aware of in order to circumvent an unwanted health crisis.

Three years ago, the World Health Organization published the WRIGHT report (WHO Research Into Global Hazards of Travel). It identified the extent of the problem and who was at risk. The report identified the population most at risk are females over 40 years of age with a prior history of deep vein thrombosis.

Others at risk include older travelers, obese travelers, pregnant women, anyone with varicose veins or a prior history of venous thrombosis, women taking birth control pills or estrogen, travelers with a history of a major operation, cancer, heart failure, highly trained athletes, and those with recent surgery or injury.

In spite of the evidence explored in our health coach certification, however, there are still airlines in denial over the problem as many fear increased litigation. One major US airline has a published statement on its websites as a response to concerned travels that reads: “There is no epidemiological evidence that air travel causes blood clots.”

However, published experts would re-word that statement.  It would be more accurate to say that “Every credible scientific study of the subject has found that air travel [and other forms of confined travel] cause blood clots, including all of the most recent, large-scale, sophisticated studies.”

What can you do to prevent blood clots?

  1. Do not be immobile for more than 1 hour when traveling by air or in confined transportation
  2. Dress in loose-fitting clothes and shoes. No socks or garments should have banded constriction.
  3. Stay well hydrated, but avoid alcohol.
  4. Exercise your legs and feet every chance you can (e.g. every 20 minutes).
  5. Consider fitted compression stockings–compression of 20 mmHg or more is best.
  6. Take an aspirin. It is not a guarantee that taking aspirin will avoid, it does prevents platelet clumping, which causes clots. If you are at risk, it seems reasonable to take aspirin daily, starting a day before departure and continuing for a day after the flight terminates.
  7. Sit in an aisle seat. You will have more room, and it is easier to stand up and move around the plane, bus, or train.

For more information search for “blood clots and travel”. There is an enormous amount of information on the subject. If you are getting ready for that big trip, obtaining this information in your health coach certification should be part of your “packing” process.

For more whole health discussions like this, listen to my hit radio show Living Above The Drama.