|
|
GreenField Health’s Health Matters: January 2006
A GreenField Update
End of Life Planning
Exercising, the Common Cold, and Upper Respiratory Illness
A Healthy, Happy New Year
--------------------
A GreenField Update
We have provided intermittent updates on our work at GreenField Health via Health Matters over the years. We do so to give you a sense of the spectrum of work that we are engaged in. We hope that you value this work – it is all aimed at making health care better for you, your family, and our community.
You probably view GreenField first and foremost as a medical practice – that is after all our primary focus because caring for our patients is the core of what we do and it is our passion. However, as many of you know, we are also actively involved in local and national activities focused on health care improvement. That work makes us quite unique and hopefully it increases your commitment to us.
Our intent is sharply focused on you our patients and the continual improvement of your care and your experience of care. Because of this, our national reputation is as a “research and development” or innovation-focused practice. We work on researching and developing new methods of providing care. For example, we still do more email and phone care per patient than almost any other practice in the country, and we continue to be actively involved in developing systems to improve care. The development of our “Transformation” weight management program is one example of this. Much of this work occurs behind the scenes in our use of technology – it may not be obvious or visible to you, but the investigations are ongoing.
We are also involved in many local and national activities focused on health care improvement. Everyone recognizes how much health care needs to change – GreenField is proud to be actively working on that transformation. In fact, GreenField derives a significant amount of revenues from paid speaking engagements and consulting. These activities constitute almost 25 percent of our revenue.
Our consulting services focus on a wide range of topics that relate to improving health care quality. Examples of our current consulting engagements include:
• Helping a local residency education program to improve physician education,
• Designing and teaching a course for an association of California medical groups to help them optimize their clinical performance,
• Assisting one of the largest US health systems to drive innovation in their medical practices, and
• Working with a group of Indian Health Service sites to implement electronic health records in order to improve their quality of care.
As we previously announced, we also had a book published in 2005 titled “Medical Practice Transformation with Information Technology.” We also published an article in the respected health care policy journal Health Affairs titled “Transforming Care: Medical Practice Design and Information Technology.” In 2005, GreenField physicians and principals were interviewed and featured in articles in over 10 national publications focused on methods to improve health care.
In addition to being on the advisory boards for several local technology companies, we also serve on the board of directors for several organizations including:
• Outside In: a local not-for-profit that works with homeless youth and other marginalized individuals to provide innovative social, medical and mental health services to help them work toward self-sufficiency,
• The Foundation for Medical Excellence: A local not-for-profit that works to promote quality healthcare and to facilitate sound health policy through physician education, research and other collaborative efforts,
• Regence Blue Cross Blue Shield of Oregon: a local insurer with a vision to transform healthcare by focusing on simplifying healthcare financing and promoting community collaboration,
• TransforMED: a subsidiary of the American Academy of Family Physicians that is working to transform family physician practices to a new model of care that looks relatively similar to our GreenField model, and
• Kryptiq Corporation: a Hillsboro-based health care information technology company and a local rising star that is working hard to promote physician connectivity that uses smart technology to help physicians coordinate patient care.
Your support is critical for all of this work – we could not do it without your dedication to our team. We hope that you value these efforts. It demonstrates our commitment to work diligently to improve healthcare. In turn, we are deeply appreciative of your support.
End of Life Planning
No matter what side of the Terri Schiavo debate you were on, you can agree that you certainly don't want to subject your family to the sort of long, drawn-out nightmare we all witnessed around her death last year. This unfortunate case demonstrates the importance of being very clear about your own end-of-life care desires and documenting your wishes in writing.
Two documents are most critical for end-of-life care planning: a living will and a healthcare power of attorney. Together, these documents are called “advanced directives.”
Please realize that it is never too early to contemplate these issues and to discuss them with those close to you, particularly those who would likely be making decisions for you in the terrible event that you were no longer able to make decisions for yourself. You should not assume that your family or others close to you either know or will be able to adhere to your wishes if your wishes are not documented. And you should not wait until you are either elderly or develop a potentially life-threatening health problem to address these issues. Speaking to loved ones about your desires for end-of-life care is important and should be done, but it doesn’t substitute for documenting your desires in the form of advanced directives.
Why is documentation so important? Documenting your specific desires is important because excessive care is frequently provided at the end-of-life, which may be in contrast to what individuals would have chosen for themselves. In other words, end-of-life care tends to be overly aggressive in providing services that have little hope of extending life in any meaningful way.
Does age matter? Age obviously does matter in that the older we get, the more likely we are to have significant health problems. While we do not suggest that those who are young and healthy create an advanced directive, it is reasonable for those in their 50s and 60s to start contemplating this. In addition, many of us have elderly parents for whom this issue is particularly pertinent – in these cases, you may want to help your parents consider these issues and make sure that they have done the appropriate end-of-life planning.
The Living Will and Healthcare Power of Attorney
A living will spells out the kinds of life-prolonging measures, care, and treatments you want if you're permanently unconscious, in a persistent vegetative state, or are terminally ill and unable to communicate. Typically, a living will specifies the situations in which you want life-sustaining treatment to be withdrawn, or not begun at all. A living will can also specify your wishes if you prefer to have all possible steps taken to prolong your life, no matter what your condition.
A living will cannot possibly cover all of the different end-of-life scenarios. So a Healthcare Power of Attorney is equally important in your planning. The Power of Attorney names the individual – sometimes called your “health care proxy” who will make decisions about your care in the event that you cannot make those decisions for yourself. The Power of Attorney can also provide that individual with specific instructions or directions. You should choose someone who, besides being close to you, is willing and able to be an advocate for your wishes, not someone who is easily intimidated or unable to stand up to authority should the unfortunate need arise.
It is important that you communicate your wishes clearly to your chosen representative because the document is only as good as the discussion on which it is based. A significant problem during critical illnesses or end-of-life situations is that there is confusion over the decision making process. Such confusion can create turmoil among loved ones. You can avoid such turmoil by specifying your desires in writing, discussing them with important people in your life, and naming the one person who will be responsible for making decisions on your behalf.
Where to get the forms and what to do with them
There are many helpful websites that provide guidance and the necessary forms – they are listed below. It's not necessary to have a lawyer review your advance directives, but it may be helpful if you have unusual wishes or expect a particularly contentious reaction from your family. Whatever form you choose, be sure to follow your state's signing and witnessing requirements.
After you've completed your advance directives – the Living Will and Health Care Power of Attorney give copies to family members, your healthcare proxy, your lawyer, the executor of your estate, your doctor, and file a copy for safekeeping. Remember that life’s circumstances change, so your wishes for end-of-life care may also change. If so, you should revise the documents and make sure that pertinent individuals receive updated copies.
Where to find additional resources
• American Bar Association Commission on Law and Aging has a Consumer's Tool Kit for Health Care Advance Planning at http://www.abanet.org/aging/toolkit/home.html. This is an excellent, thorough set of tools for reflection, discussion and documentation covering many issues related to end-of-life planning.
• The American Bar Association’s Guide to Wills and Estates, Chapter 12, at http://www.abanet.org/publiced/practical/books/wills offers helpful information related to power of attorney, living wills, and disability.
• The National Hospital and Palliative Care Organization provides very sensitive, direct information and food-for-thought at http://www.caringinfo.org, under the Advance Directives tab. State-specific forms are also available.
• Aging with Dignity's Five Wishes advance directive at http://www.agingwithdignity.org. Although the Five Wishes document is not valid in the State of Oregon, it can be a useful attachment for more thoroughly expressing personal wishes.
Exercise, the Common Cold, and Upper Respiratory Illness
Our mothers taught us that we should rest when we are “sick.” Rest is commonly believed to be important to the healing process, with “rest” meaning avoiding exercise. Is this necessary? Does rest really help you get better, or would exercise actually promote the healing process?
People can obviously be “sick” in a number of different ways. The common cold and other upper respiratory tract infections including nasal and sinus congestion, sore throats, and bronchial infections are obviously exceedingly common in adults. Most people get at least one such infection each year and they certainly can make you feel lousy. While these infections are largely self-limited viral infections, many people consider themselves “sick” during these episodes and therefore go back to mom’s advice to rest and take it easy.
However, that advice may not be the best – rest during such common illnesses may not help you get better more quickly. We all know that regular daily exercise is very important for good health. Along with good dietary habits, regular exercise is one of the most important health habits associated with many positive health outcomes.
The effect of exercise on illness has been studied and demonstrates that positive immune changes occur with moderate physical activity. The effect is two-fold. First, the risk of acquiring an infection is lower in regular, moderate exercisers compared to sedentary people. Second, regular moderate exercise may reduce upper respiratory tract infection symptoms. In one study, moderate daily exercise such as brisk walking for 60 minutes compared with inactivity reduced the number of sick days by half over a 12- to 15-week period. There is no evidence that rest is better for individuals than moderate exercise when you have an upper respiratory infection.
Exercise helps people feel both mentally and physically better. If an upper respiratory tract infection makes you feel lousy, it is likely that you’ll feel more lousy if you do not exercise. Thus, in general, if you have upper respiratory symptoms, moderate exercise is acceptable and many of us believe even beneficial. This is consistent with public health guidelines urging individuals to engage in near-daily physical activity of 30 minutes or more – and it suggests that you do so even when you feel sick from an upper respiratory infection.
A Healthy, Happy New Year
All of us here at GreenField wish you a healthy, happy new year, and ask that you call or email us if there is anything at all that we can do for you. It is our pleasure and privilege to be of service to you for your healthcare needs, and we look forward to another year of doing so.
Thanks to our corporate partners
Kryptiq Corporation
Baker-Ellis Asset Management, LLC
Stahancyk, Gearing, Rackner, & Kent Law Firm
Go to our website to learn more about these corporate sponsors https://securemail.greenfieldhealth.com/Portal/General+Info/Corporate+Partners/Default.aspx
First Tuesday Reminder
The schedule for our upcoming GreenField Health First Tuesday Open House is February 7th, March 7th, and April 4th. This is a good introduction to our practice for relatives, friends or coworkers who might be interested in becoming a GreenField patient. The sessions begin promptly at 5:30 PM on the first Tuesday of each month. Learn more about our First Tuesday Open House Online at: https://securemail.greenfieldhealth.com/Portal/General+Info/First+Tuesdays/default.aspx
Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller- beth.davis@greenfieldhealth.com
Chuck Kilo, MD - chuck.kilo@greenfieldhealth.com
Cynthia Ferrier, MD - cynthia.ferrier@greenfieldhealth.com
Dia Gaede, CMA, your Health Coordinator - dia.gaede@greenfieldhealth.com
Elizabeth Hays, MD - elizabeth.hays@greenfieldhealth.com
Eric Murray, MD - eric.murray@greenfieldhealth.com
Jill Arena, your Clinic Administrator - jill.arena@greenfieldhealth.com
Joel Swartzmiller, IT Manager - joel.swartzmiller@greenfieldhealth.com
Pam Mockenhaupt, CMA, your Health Coordinator - pam.mockenhaupt@greenfieldhealth.com
Paula Koeller, MD - paula.koeller@greenfieldhealth.com
Sarah Larson, CMA, your Health Coordinator – sarah.larson@greenfieldhealth.com
Shelly Banta, your Clinic Manager - shelly.banta@greenfieldhealth.com
Tiana Schmitt, CMA, your Health Coordinator - tiana.schmitt@greenfieldhealth.com
-----------------------------
GreenField Health System
9427 SW Barnes Road,
Suite 590
Portland,
OR 97225
Phone: 503-292-9560
Fax: 503-292-9510
Web: http://www.greenfieldhealth.com
Questions, concerns, comments appreciated:
questions@greenfieldhealth.com
copyright 2003-2006 GreenField Health
|
|