This is a topic I am very conflicted
about. I have seen both the good and bad sides of this and therefore
much of the conflict. I am not sure that I will be objective in
this, but I must try. At my age, I have been lectured to about not
having a living will or a do not resuscitate order (DNR) on file.
One doctor has been very emphatic of late and yet he will not answer
my questions. I do ask very point blank why he wants them on file
and you would think he could answer this question.
I also ask the following questions:
#1. What is the advantage of these
over a durable medical power of attorney?
#2. When and how would they be used,
or under what circumstances would they be used?
#3. Who makes the decision as to when
they would be used?
#4. Would the family even be
consulted?
Next I ask some rather pointed
questions that are not related to the above:
#1. Would medical rationing become
part of this?
#2. If our state adopts doctor
assisted euthanasia, who would determine when this would happen?
#3. Having seen doctors and nurses
ignore a durable medical power of attorney, what would stop you and
this hospital from doing this?
The discussion generally stops and
normally I receive no answers to any of my questions. I feel as a
patient I have a right to have these and more questions answered, but
the hospital that this doctor works for will not allow these to be
answered.
As a result, I will not vacate my
durable medical power of attorney and have made sure that the doctors
and hospital know this. The two articles that have me thinking are
this article and this article. Please read the second article as
this person is very knowledgeable and presents the topic of how the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
has been interpreted and misapplied as a barrier to communication
with the very people who have a deep and often lifelong relationship
with elderly patients and who will be responsible for managing or
providing care in the community.
That is right; they have been
misapplied by uncaring doctors and nurses to avoid caregivers and
often even patient advocates. During a recent hospitalization of
mine, I had a person try to pull that on me when I asked a question
on my own case. She was supposedly part of administration, but I
didn't believe her. When she said she was not at liberty to discuss
my case because of HIPAA, I had to laugh out loud. I am not proud of
what came out of my mouth next, but it was a litany of words that
were anything but polite. I basically told her that she was talking
to someone that knew something about HIPAA and she had better start
talking or I would be calling my attorney and charging her with a
HIPAA violation. She made a comment that she had never heard someone
so impolite and to put it where the sun doesn't shine.
Neither of us was aware that the
hospital administrator was outside and with her comment he decided to
enter. His first statement was that if I needed to call my attorney,
she would be the first to lose her job and that she had better return
to her duties on her floor, as a nurse, and that she would be
disciplined as well as the person that had put her up to what she had
done. She started to protest and he said, “You wish to be
terminated now,” and she scurried out. As she left he said,
“And you will be attending a class on HIPAA which I will be
teaching.” Yes, the nurse could not discuss my case because she was not authorized to see my records since she was not assigned to my floor.
Then he turned to me and commented that
this was unusual as normally I was in his office with problems. We
had a good discussion and he said that the situation would be
clarified. He said I had a right to advocate for myself and that he
did not appreciate the nursing staff thinking they could bypass the
proper procedures. As he left, he said to me that he was glad I knew
a few things about HIPAA. I tried to ask him about the living will
and DNR and said no one will answer my questions. He invited me to
stop by his office in a couple of weeks and he would give me answers.
He said that basically everyone else was not to answer these
questions.
As he got to the door, he turned and
asked about the person that could not read and write. I said that
the wife of the person that had accompanied him that day was teaching
him to read and write. I said that she was a retired elementary
teacher and that he was learning quite rapidly. A lot of words he
understood and did not need a definition for which really helped once
he learned the word. I told him that I had a call from him and he
wanted to tell me how well things were going for him and to thank me
again for pushing the envelope for him. By making his neighbor aware
of the problem, this got the wife involved in teaching him. The
administrator said that was a first for him, but that is was a good
lesson and he had added the neighbor's wife to the papers so she
could accompany him to his appointments. With that he left.
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