Healthy Living

For National Healthcare Decisions Day, a Conversation with Daniel Johnson, MD, FAAHPM, on Planning for Your Care

The Denver Hospice.   (Photo by ELLEN JASKOL)In recognition of National Healthcare Decisions Day on April 16, we spoke with Dr. Dan Johnson, national physician lead for palliative care at Kaiser Permanente’s Care Management Institute, to demystify health care decision making and understand the importance of advance care planning.

Q: What is advance care planning and why is it so important?

A: Advance care planning (ACP) is the process of planning for future medical decisions. ACP enables you to better inform and direct your care in situations where you’re not able to speak for yourself. Importantly, ACP:

  • starts with reflection and conversation around personal values, goals, and beliefs;
  • includes others – loved ones, family members and your health care team; and
  • often results in completion of an advance directive – a written plan for future medical care regarding goals of care or desired treatments for a possible or probable event.

It’s not easy to think about serious illness, much less plan for it. Yet we must. Advance care plans protect us when we cannot speak for ourselves. It’s a precious gift to our loved ones. Instead of guessing, our families and doctors have much needed guidance to ensure the right care.

Q: Why do I need to do this, especially if I’m healthy?

A: Accidents and serious illness sometimes strike suddenly. Terri Schiavo never planned for a cardiac arrest at age 26. Without prior plans or an appointed decision maker, her health care team and family were left to guess her wishes around prolonged life support. Sadly, the guessing irreparably divided her family.

Not everyone is ready to fill out an advance directive. Having a conversation with your health care team is still helpful in these instances to communicate the things that matter most to you. Appointing an agent – someone to speak for you if you cannot speak for yourself – is a crucial step at any time, even when you’re not fully sure of your wishes for future care.

Q: I already filled out an advance directive. Do I need to do this again?

A: Possibly. This question is best answered by your doctor and health care team. For example, sometimes documents filled out in one state are not valid in all states. Documents completed in the absence of informed discussions are rarely helpful (and often confusing). I would recommend re-doing your advance directives if you know your plans have changed or if you did not include your loved ones in your original planning discussions.

Q: Do I need to use any specific forms for an advance directive — from a particular care provider, for example?

A: No.  For instance, many Kaiser Permanente regions are beginning to offer our members advance care planning classes or one-on-one facilitated sessions — but no one is required to use a Kaiser Permanente advance directive form. Talk with your doctor and health care team to learn about your options.

Anyone can use Kaiser Permanente forms. Regardless of the form you use, be sure to discuss your values, preferences and documents with your health care team.

Q: How can I be reassured that the health care provider will look at my advance directive and follow my wishes?

I’d recommend two things. First, insist on including your health care team in discussions. Your physician and other providers will help you ask the right questions, explore your values, and pose important “what ifs” to help you communicate treatment preferences. The team will help you complete a written directive and assure that directive is correctly stored in your medical record. Second, include your loved ones. Ensure your appointed “agent” is present during actual conversations and completion of directives. Give copies of completed directives to your doctor, agent and other loved ones so that those who are most important to you know your wishes.

A: What happens if I want to update my advance directive? Do I need to fill out a new one?

Remember, advance care planning is not a single event. Rather, it is a series of conversations that start when we’re healthy and continue throughout our lives. Yes, refresh your discussions and directives with major changes in your relationships, personal values or health status. Your doctors (in concert with your appointed health care agent) will always use the most recently completed documents to direct your care.

To learn more, check out this article on the Kaiser Permanente Share site, or find additional resources available from NHDD.

One of the Deadliest Cancers: Is Someone You Love at Risk?

Did you know that the second-leading cause of cancer deaths among men and women combined is colorectal cancer? According to the Centers for Disease Control and Prevention, 140,000 people are diagnosed with it each year, and more than 50,000 die from it. Those are some sobering statistics.

The good news? This type of cancer is highly preventable, mainly due to screenings — starting at age 50 — that can often find precancerous polyps and early-stage cancer. Early diagnosis allows treatment to be most effective.

We can each further reduce our risk by staying physically active, maintaining a healthy weight, drinking alcohol in moderation, and not smoking.

March is Colorectal Cancer Awareness Month, and if you are looking for ways to get the word out and encourage screenings among friends and loved ones, Healthfinder.gov has a great toolkit. Web resources and sample communications are available, as well as a quiz that assesses your risk of developing colorectal cancer and a calculator that helps identify how much fiber you should consume each day.

For a first-hand account of how an at-home screening test (yes, they are available!) saved one woman’s life, check out this video from Kaiser Permanente’s Care Stories site.

For the Teen in Your Life — Listen!

Did you know that every year, nearly 1.5 million high school students experience physical abuse from a dating partner?  The startling truth is that one in three adolescents is a victim of physical, sexual or emotional abuse. These are sobering statistics — especially if there is a teenager in your life that you care about.

Yes, February is Teen Dating Violence Awareness Month.  We all owe it to the teens we love to listen — and share — this eye-opening episode of Total Health Radio, “Dating Violence:  Is Your Teen at Risk?”

In this show, Alexa Sueda, MD, talks about what teen dating violence looks like and some of the warning signs parents and friends should be watchful for. And Nancy Schwartzman, the inventor of the groundbreaking and award-winning Circle of 6 mobile app, talks about ways that young women can both prevent and cope with sexual abuse.


For more on this important topic, you can follow the conversation all month on Twitter via hashtag #teenDVmonth.

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How much do you know about diabetes?

In observance of Diabetes Awareness Month, we’re sharing the Total Health Radio episode, “Diabetes 101.”

Diabetes affects 25.8 million people in the United States. But numbers can sometimes distance us from the day-to-day realities of a serious health condition. Exactly how does diabetes affect the body? This show explores the the basics about the disease: Its short-and long-term effects on the body’s systems, and what each of us can do to reduce our risk of developing Type 2 diabetes – and live more healthfully if diagnosed.

Domestic Violence: A preventable public health problem

Domestic Violence InfographicThis month and every October, we pause to reflect on the profound impact that domestic violence has at the individual, community and national levels. It is well documented that one in four American women and one in fourteen men will be subject to domestic violence during their lifetime. We know more today than ever before about the science behind domestic violence — meaning its short-term and long-term health impacts.

Kaiser Permanente has a long track record of raising awareness and taking action on this topic for the benefit of the many lives it insures (many of whom are employees of the company). Its efforts were recognized last month by Peace Over Violence (a Los Angeles based non-profit whose goal it is to eliminate violence against women, youth and children) in the form of a corporate humanitarian award. This honor came about because of Kaiser Permanente’s leadership in partnering with the NO MORE campaign to raise public awareness about this issue via funding for programs serving survivors.

This week, the Institute for Health Policy website published an updated version of the article I authored in 2012 that highlights Kaiser Permanente initiatives and the gains over the last decade. A shining example is the implementation of an innovative approach for domestic violence prevention that was first piloted and launched in Kaiser Permanente’s Northern California region. In the words of Brigid McCaw, MD, director of that region’s family violence prevention program: “Transforming the health care response to domestic violence requires going beyond the traditional focus on didactic training for clinicians. Kaiser Permanente’s successful ‘systems model’ approach demonstrates that domestic violence prevention can be effectively incorporated into everyday health care services.”

You can read the story in its entirety at the Institute for Health Policy site.

Leadership Perspectives: Good Health Starts Where You Are

Editor’s Note: Today, we launch a recurring feature on the Center for Total Health Blog. “Leadership Perspectives” is a collection of guest blog posts from Kaiser Permanente leaders all about why we need to take a Total Health approach.

Today’s guest author is Elisa Mendel, national vice president of HealthWorks & Product Innovation for Kaiser Permanente, who shares her thoughts on place-based health.


 

How much time would you guess you spend at work each year? Would you be surprised if I said it’s something like 2,000 hours?

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Compare that to the time we spend with our doctor — maybe 15 minutes once or twice a year? That’s why place-based health is so important. At its core, good health starts with us — where we live, work, learn, and play.

That’s one of the reasons Kaiser Permanente partnered with leading national organizations to launch Thriving Schools. The idea is that schools are the hub of every community. Our work in schools focuses on four key areas: healthy eating, active living, school employee wellness, and a positive school environment. One of the active living programs is called Fire Up Your Feet. Fire Up Your Feet’s fall campaign launches October 1, and it encourages kids to walk to school with their parents, giving them much-needed exercise and some quality time together.

Another initiative I really love combines the childhood enthusiasm for play with the workplace. It’s called “Instant Recess.” A manager or wellness champion schedules time with their team —usually about 10 minutes. Everyone stops what they’re doing, and one of the team members leads the group in dancing and exercise. People are moving, getting their blood pumping, and laughing together. It’s had amazing results, because when you’re doing the chicken dance with your supervisor, suddenly things feel a little less stressful.

Kaiser Permanente piloted this in various work settings — call centers, IT, and even the ICU. One of the ICU patients heard the staff doing this Instant Recess every day on the floor and she was determined to get out of bed so she could be wheeled out to participate in the fun.

There’s no limit to the benefits of healthy living. It can lift spirits and deliver real business results. One study in the Journal of Occupational and Environmental Medicine showed that employees who ate healthy and exercised regularly were up to 27 percent less likely to be absent from work for health reasons.

Good health is becoming a national movement. Find your “healthy,” and start to share good health close to your home.

Domestic Violence: It’s a Health Issue

October is Domestic Violence Awareness Month — a good time to pause and consider just how many people are affected by domestic violence and sexual assault. The numbers are astounding. According to the National Coalition Against Domestic Violence, an estimated 1.3 million women are victims of physical assault by a domestic partner each year. And one in every four women will experience domestic violence in her lifetime.

Adults aren’t the only ones affected. Every year, nearly 1.5 million high school students experience physical abuse from a dating partner. One in three adolescents is a victim of physical, sexual or emotional abuse.

This episode of Total Health Radio talks about what teen dating violence looks like and some of the warning signs parents and friends should be watchful for. Guest Nancy Schwartzman, the inventor of the Circle of 6 mobile app, shares ways that young women can both prevent and cope with sexual assault.

The Best Community Spaces come from the Community

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Editor’s Note:  We have invited Scott Kratz, director of 11th Street Bridge Park to share with us some of his experiences as he takes this vision of a shared community space that supports health from concept to reality.  This is his second post with us. You can see his first post here.

Walking in a city park, have you ever experienced that frustrating moment? Maybe there’s no place to sit down. Or no shelter from the sun. Or there’s no family-friendly restroom in sight. The best civic spaces respond to the needs and desires of the community, but too often residents are left out of the design process. At the 11th Street Bridge Park, we’re working to change that with our new civic space in nation’s capital.

Together with the Washington, D.C. city government and a local non-profit organization “Building Bridges Across the River at THEARC” we’re transforming an aged-out freeway into a new park over the Anacostia River. After an extensive community outreach effort with more than 350 community meetings to date, we have created an amazing list of ideas for our park that were incorporated into a nation-wide design competition.

A primary goal of the 11th Street Bridge Park is to improve public health with this iconic new space. It will offer a safe place to play in a neighborhood that has the highest rates of obesity, and will incorporate healthy edible landscapes that can serve as a backdrop for farmers markets and planting/ harvest festivals for residents that have the lowest access to fresh fruits and vegetables in the region.

The design competition jury shortlisted four teams earlier this year, made up of the best landscape architects, architects and structural engineers in the country. After working all summer and meeting repeatedly with community stakeholders, the four teams submitted their renderings last week.

Now we want to hear from you. After reviewing the concepts here, tell us what you think! Take a short survey evaluating how each design meets our four key project goals. The results will be shared with our competition jury as it makes the final selection. We’ll announce the selected team on October 16. Stay tuned!

Reversing the Epidemic of Inactivity

EVS Pic - Black Bold SmallerIn the final installment of her seven-part series on Exercise as a Vital Sign (EVS), Kaiser Permanente physician Latifat Apatira blogs about how far we have come and the long road ahead toward reversing what she describes as “the epidemic of inactivity.”

She writes that health care providers have a duty to evaluate each patient’s physical activity habits. And that Kaiser Permanente is moving in the right direction through efforts to work closer with community partners on a wide range of initiatives aimed at promoting exercise and healthy living.

“To combat inactivity, we need programs like EVS,” Dr. Apatira writes. “But we also need changes in our policies, built environments, and culture to reframe the role physical activity plays in our lives every day.”

Physical activity, she writes, needs to be something that people do not only because it’s the healthy choice, “but because it’s the easy choice, the comfortable choice, or the fun choice.”

Read the blog in its entirety:

What We All Should Know About Headaches

Is there anything that can get in the way of your day’s activities worse than a headache? We’ve all been there. But did you know that there are several different types of headaches you may be suffering from – and each has its own causes? It’s true. The good news: There are things you can do to deal with – and sometimes even prevent – the headaches plaguing you. In this episode of Total Health Radio, our guest physician walks us through the different types of headaches, shares how we can identify our own personal triggers, and explores options for how we can best manage headache pain when one strikes. Have a listen.

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