MN058 Patient's Are At Risk in ER's Across the U.S.

Medicare Nation

Welcome, Medicare Nation!

I’m excited about our guest and our important topic today. We’re discussing the confusion surrounding advanced directives. Have you ever thought about what would happen if you can’t speak for yourself and are in an emergency health situation? Who will express your wishes, and will the health care professionals understand? Dr. Ferdinando (Fred) Mirarchi is the ER Director of University of Pittsburgh Medical Center-Hamot. He has a solution!

• Tell us about health care directives and the issues that commonly arise when people come to the ER.
• • There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise the safety concerns.
• What happens when someone comes to the ER with no accompanying family and no papers?
• • It’s not just an ER situation, but anywhere in the hospital, for any medical procedure. “You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means.” About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you’re an end of life care patient and don’t want care. Many don’t understand the difference between being critically ill and being in an “end of life” situation.
• If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
• • Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn’t compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
• Can you explain the difference in a Living Will and a DNR?
• • A Living Will is a legal document, not a medical document. It is for use in situations when someone can’t speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it’s a DNR, then it can affect care and treatment of any medical emergency. “It’s a coin toss with a 50% chance of being treated or not being treated.”
• You’ve developed a solution to help people explain their wishes about receiving treatment. Can you explain?
• • At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
• Will this ID card work in any medical office, hospital, or ER?
• • Yes, and it’s in clear and understandable medical language so that any professional will know what to do.
• Can you explain how to find out more and what the service includes?
• • Visit our website: www.institutehcd.com or email us: [e-mail]. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you’re at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry.
  • Here is the news story video of the 57y.o. man who was mistakenly noted as "DNR" in his hospital file
• whistle blower 9 Investigative news

  • http://www.wsoctv.com/news/9-investigates/whistleblower-9/whistleblower-9-do-not-resuscitate-bracelet-mistakenly-put-on-hospitalized-mans-wrist/446014450

    Here is a Parody Video on "Advanced Directives"

    https://youtu.be/S6XKv7MOuts

    Good Practice (A parody of Green Day's " Good Riddance")

    By Michael Barton

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