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Sunday, October 16, 2016

Writing Your Medical Autobiography

Many of us have thought about writing our autobiography to share with family and friends our life experiences and insights as we travel the road we call Life. Although this might seem foreign to many, sitting down to write about yourself is a good idea. Recently, I had the opportunity to join a colleague on a radio show to talk about the value a patient advocate can bring patients and their caregivers when a medical event thrust them into the complex would of healthcare. To listen to the show click here.

It was an interesting experience, and I learned a lot as part of the process. During one of our breaks, I met Francine Yaffa, a professional organizer.  Francine was listening to our discussion on the show and offered a suggestion that we share information on the importance of writing a personal medical autobiography. I had not heard this term before and asked her what a medical autobiography was. She explained a medical autobiography is another name for a Personal Health History that a person develops, so they have all of their current and past medical history in one document.

I thought this was an excellent idea and wanted to share information in this week’s post so readers could become familiar with the concept and start their medical autobiography.

Having a personal medical autobiography allows each person to reflect on their life, their health history and allows them to see how their health history changes over time. Documenting the information can provide insights into how you are doing, the progress you are making and how the treatments you have taken in the past or are currently receiving are working. 

Reflecting on this information allows you to ensure your health and healthcare are meeting your goals. In addition, having this information in print allows you to share your information with your providers and others charged with speaking for you if and when you cannot speak for yourself. Most importantly, your medical autobiography allows others to get to know YOU.

I asked Francine to share with me some of the points that she recommends to be part of a Medical Autobiography. Here is what she recommended. I also added a few ideas that you might want to consider.

Your name, address, home and cellular phone number, email address

Emergency contacts names, addresses, phone numbers, email addresses (note if any of these contacts are the person’s health care surrogate and power of attorney)

Medical Insurance information: note your insurance information with your ID numbers and phone numbers. If you have long term care insurance include that information also.

Prescription Insurance: company name, phone number, Policy #

Prescription Medications. List all of the medication you take. Write the names exactly as they are on your medications bottles. Note the dosage, times you take the medications and the date you started taking the medication as well as the reason for taking it

Over-the-Counter Medications and Supplements also should be listed. List all of the information noted above for your over the counter medications and supplements.

Note all of your health, dental and vision conditions including date of onset

Note any and all surgeries you have had. Including the date/year of the surgery, the surgeon’s name, the reason for surgery

List all of your physicians: note their names, specialty, address, telephone, fax, email, patient portal link along with your username and password.

If you are a snowbird, list the doctors whom you see in your hometown as well as the providers whom you visit when you are at your vacation home. The document allows your physicians to communicate with each other as needed.

List any allergies to drugs, food and environmental allergies. 

Note any food sensitivities, diet restrictions or preferences (for example gluten/lactose intolerance, vegan, kosher, etc.TIP:  If you have allergies/food sensitivities you might want to move this section up on the list under emergency contact information so that it is right at the top of the page as it will be more noticeable to the healthcare provider. You can also use a yellow highlighter to highlight the headings “Allergies” and “Food Sensitivities” (or type these headings with a RED font and print the document with a color printer so important points stand out

Hospital where you would be admitted. Include the address and phone number. 

Rehabilitation centers/facilities you are currently using or have used in the past. Include the address and phone number

Urgent Care Centers you have used. Include the address and phone number

Laboratories, where you get your blood work is done. Include the name, address and phone number

Facilities, where you get your diagnostic testing done. Include the name, address and phone number

Durable Medical Equipment being used, such as a walker, cane, wheelchair and the company where you have obtained the equipment. Include the name, address and phone number

Miscellaneous information: For example, copy of the card the doctor gives you to show the location of implantable devices as well as the serial numbers that identify the devices. These cards have important information that physicians would want to have in case there is a problem with the device or implant. Examples of implantable devices are stents, pacemakers, joint replacements, etc.
Copies of your Healthcare Surrogate document, your Living Will, your signed HIPAA forms, advance directives.

If you have contacted with a professional healthcare advocate to assist you in navigating the healthcare system, include their name, phone number and email address. 

Make a list of all of your financial information with your account numbers and directions on who do contact when needed.

Names, addresses, phone number and email of your Attorney, your Financial Planner, your Accountant, your Bank and other financial institutions where you have accounts. These could include retirement accounts.

Your place of Worship. Many people want their names placed on a prayer list or have someone from the place of worship to visit them if you are housebound

If you have made pre-arrangements with a Funeral Director, include the name, address and phone number.

If you have a description of how you want your funeral planned out, include that document so you can make sure your wishes can be implemented. Items to include could be your favorite scripture passages, music you like and people you want to make sure attend and what you want them to do.
This document should be kept in a safe place as it contains sensitive information. Having developed the document, allows you to print out your medical autobiography and provide it to your doctors so they can have the information for their files.

A digital copy should be kept on a flash drive and be kept your wallet as well as saved on your person’s computer. Having the document on your computer allows you to update the document as your health history changes.

I hope this post will inspire you to develop your Medical Autobiography. Doing so allows you to be an active participant in your health and healthcare journey.


File for Life: designed to make the difference between life and death by providing vital information to first responders. The File of Life format is modeled to be easy for patients to use and immediately recognized by local EMTs, police and fire departments nationwide. File of Life strives to maintain an open dialogue with communities across America to provide the most up-to-date, effective products and information possible. To learn more click here

A Letter of Instructions to My Family:  In addition to your current Will, a Power of Attorney and a Living Will, individuals are encouraged to plan ahead and write messages to their family and executor detailing their specific desires regarding funeral and burial. Written instructions to your family and executor containing information and guidance will minimize uncertainty, confusion, and possible oversights following your death.  The information you furnish should ease the settlement of your estate and provide for an orderly winding-up of your affairs.  You need to share what you know with those who (often suddenly and without warning) must step into your shoes and carry out your final needs. For a sample letter of Instructions click here.

Five Wishes: Five Wishes is America’s most popular living will because it is written in everyday language and helps people express their wishes in areas that matter most — the personal and spiritual in addition to the medical and legal. It also helps you describe what good care means to you, whether you are seriously ill or not. It allows your caregiver to know exactly what you want.  To learn more about Five Wishes, click here

Professional Organizer: As I mentioned, the idea for this post come from a friend and colleague, Francine Yaffa of Francine Yaffa Organizing. As a professional organizer, Francine provides solutions to simplify lives by reducing clutter and putting streamlined systems in place. This optimizes space, time, and tasks and helps to increase productivity, accessibility, and functionality. Francine can help organize your personal health information onto one simple document as described in this post. You can reach Francine at / 954.970.0415

I hope this information inspires you to create your own Medical Autobiography to share with those who you trust to have the information. If you have done this already, please take a minute to share how it has helped you to be an empowered patient. 

Thank you for reading Nurse Advocate. Have a good week!

Saturday, October 1, 2016

The Joys of Traveling as a Disabled Person

I love to travel and considered myself a ‘road worrier’ during most of my career. I found traveling fun despite some of the challenges that we all encounter as part of the process.  Today, airports are getting bigger, so the distance between gates is longer. Also, flight schedules are tighter so getting from one gate to another can be a challenge especially if your departing flight is late taking off.

As a newly disabled person, travel has changed for me.  Today I need to prepare more and be cognizant of how I will get to my gate when I arrive at the airport or get to baggage claim once I reach my destination. If my flight is not direct, I need to make sure I request a wheelchair to take me to my next gate as the distance between gates in most airports can be quite long.  

I was recently introduced to a reporter from the Wall Street Journal by a colleague. The reporter was doing a story on the fact that airports were getting bigger causing walks to gates to be up to a mile long which is causing challenges for all travelers. As part of this story, he wanted to include how airport expansions have impacted the elderly and the disabled. I was glad to talk to him as I had taken a few trips recently that opened my eyes to the challenges people have when traveling especially the elderly and the disabled. Here is the link to the article in the Wall Street Journal. 

As the article did not fully capture the points I felt were important, I thought I would share them in this week’s post as I realize travel is important to many people whether able-bodied or disabled.

One of the things I have learned as a newly disabled person, is that I can still travel, but I need to take the time to prepare and be alert for resources that allow me to navigate in a safe manner.  I felt this was an important post as many readers of Nurse Advocate are challenged by disabilities in one form or another. Other readers are healthcare professionals who can help their patients know some of the challenges they are going to face when they travel and how they can help them avoid problems by being prepared. Here are some of the tips that I have learned traveling as a newly disabled person.

The most important thing that I can recommend is to plan ahead and make a list of things you will need so you are safe and can continue your treatment during your journey.  Second is to make sure you give yourself plenty of time, so you do not feel rushed, can handle setbacks that occur. This will allow you to be prepared, decrease your anxiety and have good experience.

Traveling by air is an efficient way to get from one place to another. Most people prefer air travel if their destination is more than four hours from their starting point. If less than four hours, consider driving your car as it might be more effective and comfortable for you. Having your own vehicle allows you to stop when you want and be on your own schedule. 

Air travel for the elderly and the disabled can be a challenge but by preparing you can be assured you get the assistance you need. When you make your reservation online, you will see that most sites have an area that you can check if you need special assistance. If you do not see this on the web page, call the airlines. Recently, I flew American airlines and did not see a place on the website to check that I needed special assistance.  When I called the reservation line, the person told me, that they took that section off the website as they wanted people to call them with their special request.  I was able to tell the person I needed a wheelchair to get to my gate when I landed between stops.

If you are not able to handle your luggage, you can check it in when you arrive at the airport. This frees you up and makes the possibility of forgetting or losing something less. If you are carrying your bags onto the plane, make sure you are aware of the ‘rules’ and comply. On most planes, you can take one bag and one small carry-on onto the plane. If you are over the limit, you will have to check the extra bags so make sure you know the rules and comply. If you have medication, keep them in your carry-on in case your checked bags get separated or delayed.

As I have to wear leg braces to ambulate safely, I usually ask the TSA people if I need to remove the braces to go through security. Depending on the airlines and the security, they have allowed me to go through security without having to take them off. As the alarm usually is triggered, I usually have to get wanded, but because I arrived early enough, this extra procedure was not a problem. 

As a disabled person, most airlines allow you to board the plane early so you can get your luggage stored before general boarding. This is a help as many people need a little more time and by boarding early, you do not hold up the line as you get settled.

I have been impressed by the systems that the various airports have in place for people who need wheelchair assistance. Most times, my wheelchair is waiting for me when I deplane. The people pushing the wheelchairs are courteous and help you with your bags and make sure you get into the wheelchair safely.  On the way to the gate, I have been asked if I needed to use the ladies room before getting to my gate. I thought this was so thoughtful as I try not to use the restroom on the plane if possible. If the distance between gates is long, you might be greeted on arrival with a wheelchair but taken to a central point where you transfer to an electric cart. Again, most of the major airports have their systems down to a science and are efficient in getting people from one gate to another. It is customary to tip the wheelchair attendant for this service. If you are satisfied with the service, please be generous as these people work really hard. 

For those with ambulatory issues once seated, they are usually ok, but if a person has other needs such as oxygen, the stewardesses are very helpful in getting things set up. Again, making arrangement ahead of time helps prepare the staff. Fellow passengers are usually helpful to those with special needs so don’t be afraid to ask for help if you need it.

If you are traveling by another means, like a train or bus, there is similar assistance available when requested.

When we were on a cruise a few months ago, the ship had resources for those who needed assistance with a variety of needs. Don’t be afraid to ask for help as it is usually can be provided or recommendations on how to accommodate the person can be discussed.  I shared our cruise experience and how it compared to the customer service in the hospital in a post in Nurse Advocate titled; Going Beyond Expectations to Create a Culture of Caring. If you do not recall reading the post, take a look as it will give you some good ideas on customer services that can help many in healthcare be more proficient.  

If you are going to be staying in a hotel on your trip, you may want to consider asking for a handicap room if needed when you make your reservation. I have been disappointed in some hotels as their handicap rooms are not always equipped to help a person. So it is important to be careful when you are in a hotel as it is different from your home. Things you take for granted might not be the same in a hotel. An example is the towel rack.  Do not depend on the towel rack being sturdy enough to hold your weight, so if you are off balance and need something to hold on to look for something that is sturdy. Another area to be mindful is getting in and out of the tub/shower. Most hotels have grab bars which help but be careful, so you do not slip and fall.

Make sure you pack your medication and keep it in your carry on bag as well as any equipment you might need.  On a recent trip, I forgot my medication. I called the local Walgreen’s (the same pharmacy I use at home). Unfortunately, the cost to get a few pills was cost prohibitive as I was between refills. Thankfully my husband was home and could overnight a few pills to where I was staying o I could stay on schedule. 

If you need other equipment while you are traveling, talk to your doctor. If you have a case manager or a patient advocate whom you are working with, ask them as they will be able to help you make arrangements so things can be delivered to you once you arrive.

As with everything I do now, pre-planning is important. By taking the time to prepare, I realize I can still travel and enjoy life.

Thanks for reading this week’s post. If you have had an experience while you were traveling you would like to share, please post in the comment section or email me at

Have a good week! 

Sunday, September 25, 2016

Considering Spirituality and Faith in Managing Life’s Challenges

Of the many things that assisted me through my healthcare journey, I have to say that my faith helped me the most. I have not talked about this before because it is personal. However, recently, I have been thinking about how important my faith was to me during my healthcare journey, that I wanted to share a few thoughts on this topic as it might help patients and caregivers consider the value of Faith and Spirituality in managing life’s challenges.

As I progressed on my journey, I realize that I took my faith for granted till I was diagnosed with a Central Nervous System Brain Tumor. I would go to church, say my prayers, try to live my life as a ‘good Catholic.' However, it was not till I got sick that I realized how important my faith was and how much courage I received from my faith. I needed to know that there was,  a higher power if you will, that I could turn things over as I had no control. Because of my faith, I believed turning to God would give me strength to face the challenges of fighting cancer. I gained peace of mind from the prayers I said and were said for me by family and friends.

When I was in the hospital, I looked forward to the visits from the Catholic priest from Camillus House who was assigned to Sylvester Cancer Center. He made rounds on the patients who had asked to see him. I learned about the opportunity to see a priest, from the Unit Secretary who worked on the floor I resided for my chemotherapy. She said if you want to see the priest, call the operator and give her your name and room number. That way she will put you on the list, and the priest will see you when he makes rounds. The priest did come to visit me several times during my various stays. We had good conversations that lifted my spirits and helped me see some of my fears more clearly which helped me cope better.

When I was home, I received Communion from the team of Eucharistic Ministers from my church, St. Gregory the Great. By calling the Parish office and putting my name on the list, it allowed the team who coordinated home visits to know that I was requesting a Euchuristic Minister to visit and receive Communion as I could not get to Mass. I looked forward to them coming, talking with them and taking a minute to say a pray. It was comforting, and I am thankful for the opportunity they provided to turn my attention away from myself and focus on my faith.

In doing research for this post, I read about Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp. He shared: “Man is not destroyed by suffering; he is destroyed by suffering without meaning” My faith gave me meaning and helped me cope with the challenges my husband and I were facing. One of the challenges all involved in healthcare face is trying to help people find meaning and acceptance in the midst of their suffering. Experts, remind us that religion and spirituality form the basis of meaning and purpose for many people.

So many people struggle with the physical aspects of their disease, yet when we are faced with our mortality, we are faced with mental and spiritual suffering as we try to find answers to some of the deepest questions of life. Some may ask: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me?

I remember a conversation I had with a friend via email as I was trying to rationalize how and why I got a brain tumor. Here is a snippet of our e- conversation: Take a minute to ponder her words.
How does illness happen? Why does illness happen? The 'why' and the 'how' are connected. Medicine can give us their best interpretations but rarely know 'how' we become ill and even more importantly 'why' we become ill. Since illness is our experience, we must answer these questions for ourselves. The author's position is grounded in the psycho-somatic connection that we rarely live in until we are sick. Illness demands our attention and maturity.  We are called to become our own healers. What we thought were important changes. What we thought was urgently becomes less demanding. Our indispensability becomes humorous. Our isolation is broken by our dependence on others.  We change because the world is the same, but different. We are humbled! Illness that threatens our life can actually save our life if we go-within to become our own healer. 

If you are a patient reading this post, take some time and reconnect with your faith. Take time to reach out to your place of worship and request a visit or to be put on the prayer list.  Take the time to read thought provoking books allows you time to explore your feelings, your joys, your fears, and uncertainties. Doing so allows you to unburden yourself so you can cope better with the challenges and uncertainty you face. 

If you are a patient, I hope this post gives you the inspiration to explore your faith and experience the healing power it can bring.

If you are a healthcare professional reading this post, take time to talk to your patients and their caregivers about their faith and provide the privacy they need to practice their faith. 

Thank you for reading this week’s post in Nurse Advocate! Sending positive thoughts to you and yours.

Saturday, September 17, 2016

The Teachable Moment

Today, finding that ‘teachable moment’ is so important. Life is all about learning, gaining a better understanding of the events taking place so we can make better choices that can enrich our lives. This could not be truer than in healthcare. 

Today, there is a focus on ensuring that the patient is the central member of the healthcare team. Evidence shows the the more we engage the patient, the better the outcomes will be. 

Everything we do as healthcare professionals revolves around the patient, so it is in our best interest to educate and empower them, so they are informed, educated and know the choices they have regarding the treatment they receive. Many healthcare professionals are more cognizant of this and are taking the time to educate and empower the patient and their family, so they understand their conditions and the plan of care. 

In this week’s post, I would like to highlight two examples of 'teachable moments' I experienced during my healthcare journey. Each helped me be a more informed patient so that I could help myself heal and better participate in my care. 

The first example came when I was in the hospital getting my 5th round of chemotherapy. My nurse for the day came in and introduced herself. We talked as she updated the whiteboard in my room with her name and how I could reach her if I needed her. Then she turned to me and asked me what my goals were for the day.  I looked at her for a minute as no one had ever asked me that question before. She explained to me, she wanted to help me reach a few of my goals today, but to do that she needed to know what they were. I thought about it and told her that I wanted to get a shower. I also said that I wanted to take a walk so I could get out of my room for a little while. These were not easy goals to achieve as I was hooked up to IVs and needed help to get into the shower as I was very weak. The nurse was not put off by the task. She said, ok, let me check on my other patients and then I will be back so we can get started on helping you meet these goals.

When she returned, she got me ready to take a shower. She gathered towels and put a chair in the shower so I could sit down once I got in there. I asked her about the IVs, and she said, don’t worry, we can unhook you for a short time. She then went and got a shower sleeve that she put over my arm where the pic line was so it would not get wet. This allowed me to wash myself and not get the line wet. It felt great having hot water run over my body. I was even able to wash my hair. Once done, I put on a clean gown which felt great. She reconnected the IVs, and I  got back into my bed to clean sheets. My nurse and the aide were able to change my bed while I was in the shower. 

After I had rested for a while, the nurse came back and asked me if I was ready for my walk. She got me up, and we took a short walk up and down the hallway. It was fun seeing the other patients and staff whom I passed. Each said hello and asked me how I was doing. I felt good and I was glad that I had achieved my goals. I was grateful to my nurse for asking me what they were.

The second teachable moment occurred during a conversation my husband, and I had with the pharmacist who was a member of my oncology team. It was Week 4 of my chemo treatment. My Hematologist had just told us that my tumor was GONE. Both my husband and I were in shock, as we had not expected that news so early in my treatment. 

As my team was making rounds, the pharmacist stayed behind for a minute to ask me a question. After I answered him, he asked me if I had any questions for him. I took this opportunity to ask him how the tumor could be gone? I told him we were happy and grateful, but we did not understand how this could happen just after three treatments. He explained to us that the protocol I was on was meant to work fast - if it was going to work. As a result, the team expected the tumor to be gone after the 3rd round of which is why they scheduled the MRI after the 3rd chemotherapy treatment. He explained that in my case, the tumor was very receptive to the chemotherapy and as a result, the tumor was gone. His explanation helped me to understand and realize there was a science to the treatment I was receiving. His explanation made me very grateful that I had been referred to my hematologist who had specialized in the type of tumor I had for years, had developed a protocol to treat the tumor type and that my tumor was receptive to the therapy and was GONE. 

I asked the pharmacist about re-occurrence. He said ‘there is a high probability of re-occurrence, but that is why the doctor will watch you for two years.’ I asked him if the tumor returned would I get the same type of treatment. He said that he did not know and that my hematologists would determine the course of treatment if and when the tumor reoccurred. He said, for now, just relax.

These two examples showed me the importance of finding the teachable moment and taking advantage by educating and empowering a patient.  Each example allowed me to be involved and better participate in my care. It showed me that, by setting goals and asking questions, I could better understand my care and help myself heal.

If you are a patient or a caregiver reading this post, I hope the words empower you to ask questions, so you better understand your care. Each member of your team is there to help you to understand your diagnosis and the plan of care that in place to treat your condition. If you have questions or want to do some things that will help you to feel better, do not hold back. Know that taking care of you is the most important thing that they have to do.

If you are a healthcare professional reading this post, I hope this post helps you realize there are teachable moments in every encounter. Please take the time to engage your patients. Ask them questions, learn who they are and how they are feeling about themselves and their conditions. These conversations lead to those teachable moments that help your patients and their caregivers to be involved in their care.

If you have an example of a teachable moment that you experienced during your healthcare journey, please feel free to share in the comment section or by emailing me at

Thanks for reading Nurse Advocate and have a good week!

Monday, September 5, 2016

The Search for an Individual Health Care Insurance Policy: Not as Easy as it Sounds

In this week’s post, I wanted to share a challenge I had as I went about the process of searching for an individual healthcare policy to replace my COBRA policy as it was expiring. 

Having healthcare insurance has never been so important to me because I realize that having a good policy allowed me to have access to providers and hospitals who saved my life when I was diagnosed with a life-threatening illness in November of 2014.  

Today, most people receive healthcare insurance through their employer as part of their employee benefit plan. For most of my career, I have been fortunate to have an employer-sponsored health care plan and thought little of how my employer put together the package they offered. For those who do not have health insurance offered by their employers, the Affordable Care Act has created a way individuals can buy insurance through the Market Place.

When I was not able to return to work in March 2015, I was offered COBRA by my employer. The COBRA policy allowed me to continue my health care insurance plan without interruption. This was a huge relief to me and my husband as the policy allowed me to have access to the doctors who had the expertise to diagnose and treat me for the brain tumor that threatened my life. If I did not have that policy, there is no doubt that we would be in a tremendous amount of debt and worse, I might not have survived. 

COBRA is a bridge that allows a person who has to leave their job to continue their insurance coverage till they can return to work or get an individual policy. In most cases, COBRA lasts for 18 months but under certain circumstances, can be extended to 36 months. Most people return to work and continue coverage under their employer-sponsored health care plan. Others use the opportunity to test the waters of independent practice. For those who do not return to full-time work, or their employer does not offer insurance, they have to search for an individual or family healthcare policy.

Finding a health care insurance policy to meet an individual needs is not an easy job. As most people do not have experience to understand what makes up a good policy,  many people turn to an insurance broker to help them understand their options or to the healthcare marketplace that was created by the Affordable Care Act.  

The Affordable Care Act has changed many of the rules that in the past made it difficult for people who had a medical or mental health condition (often referred to as pre-existing conditions) to purchase health insurance. Before the ACA, insurance companies could deny a person coverage because they had a medical condition as part of their medical history. 

As a result of the ACA, this is no longer possible. Today, when you look for an insurance policy, your medical history does not come into play. This has helped many people be able to purchase health insurance who in the past would have been denied.

The ACA has also changed how people search for insurance. In the past, many people worked with an insurance broker to learn about the policies available and which one’s met their needs. Brokers had the expertise to understand how policies worked and could give their clients advice that served them well. Most times people would choose the policy that allowed them to see the doctors who were currently treating them and go to the hospital where those doctors had privileges. With the development of and State Insurance Exchanges, brokers are being displaced, leaving the search up to the consumer. 

The platforms that are in place allow the consumers to search for insurance. They are not difficult to navigate and provide information that enables the consumer to make an informed decision by comparing various policies which are available.

The Healthcare Market Place is available to help people search for insurance. This task may be easier for people who do not have medical conditions and do not have a preference as to the doctors they see or the hospitals they prefer to be treated if they had an injury or a sudden illness. However, for those who have specific choices, the process is not as simple.

To control healthcare cost managed care companies set up provider networks which members have to use or pay higher out of pocket costs if they decide to go ‘out of network.' This has raised the bar and put pressure on the consumer, especially those who have medical conditions which require continuous care to make sure their doctors are part of the managed care network when they search for health insurance.

Another cost containment strategy many managed care companies are implementing are narrow networks. Narrow Networks limit the number and type of specialists that members have access. If you want a plan with a ‘wide network’, you will pay a higher premium or higher out of pocket costs. 

Some companies also have tiers and categorize providers and organizations according to their specialty and risk factors for the patients they see.  Specialists who provide care to complex patients are classified in a higher tier, so the consumer needs to pay higher out of pocket costs if they want to see a specialist. Providers and organizations who are in the higher tier categories have higher costs than those in lower tiers. Diagnostic testing, lab work, and other services like rehabilitation programs may also fall into tiered levels.

As a result of these things, looking for a healthcare policy is complicated and raises the cost of insurance for the consumer.

What is even more frustrating is that the managed care insurance companies can choose to pull out of an area when they find the area is not profitable,  leaving members to find new coverage and providers. Providers also are in a precarious position as their rates are negotiated by the the managed care network as part of their provider network contracts.

Another thing that was eye opening for me as I explored new policies was unlike other types of insurance you may purchase; you cannot purchase health insurance other than during the open enrollment period (November-January) or when you have a qualifying event.

As with many things related to healthcare, the system seems to be set up to benefit the insurance company instead of the consumer. To find effective and affordable coverage, the consumer has a tremendous amount of work as they navigate a complex system with strict rules, regulations and high costs.  Little training is available to help consumers understand the complex insurance industry so consumers need to take the time to learn the system as much as they can when they are in need of a policy.

Here are some tips that I learned from my experience of searching for an individual healthcare policy. 

  • Give yourself time. It takes time to find the right policy, so give yourself the time to do the research and find a policy that meets your needs.
  • As for help:  if you know an insurance broker, set up an appointment to discuss the process of buying health insurance.
  • If you do not know a broker, each State and county has Insurance Navigators who can help you understand the process. Navigators are familiar with the plans in your area and can help you find a policy to meet your needs. If you find yourself confused, don’t hesitate to ask for help.
  • Take time to get familiar with the technology in place that helps you search for health insurance. The two systems I used to during my search were and Costco. (Yes, Costco sells health insurance, and you do not need to be a member to use the system). Both sites were user-friendly and allowed me to view and compare various plans and their costs. If you have questions, both have assistance available. 
  • Make a list of what you would like to have in a policy. If you want to see certain doctors or go to a specific hospital, write the names down so you can check various managed care networks you are considering to see if those providers and organizations are part of the managed care network. You can do this online by going to the specific managed care organizations website and clicking on the tab that says find a doctor. Plug in the names of the doctors or facilities. These online provider directories are open for anyone to search.
  • Once you checked the online network, call the provider to verify they are in the network. Many times the online information is not up to date, and a provider may have dropped out of the network in-between network updates, so checking with them is another step in the process. Most doctors and hospitals are used to calls verifying network participation so don’t feel shy about asking.
  • As you look at policies, compare several to see which one’s meet your needs. In addition to checking for providers you want to see, look at the premiums, the out of pocket costs, and the deductibles of each policy so you can see the differences and decide what you can afford.
  • Depending on your income, you may qualify for a subsidy or tax credit from A subsidy can help you afford a higher price plan, so it is worth checking out.
I am happy to say that I found a policy that I believe works for me. My qualifying event that allowed me to buy insurance outside of the open enrollment period was that my COBRA policy was expiring on September 30th. Unfortunately, my premium is going up, and I will have higher deductibles and out of pocket costs with this new policy. This is because my choices were limited I live in Florida, and many of the managed care organizations do not offer coverage in the State so choices are limited. 

I will only have the new policy for a few months, until the open enrollment period opens November 2016.  Once enrollment opens the manage care companies release what States and Counties they will provide coverage for 2017 and the cost of each plan. Once this information is published, I will be able to review the choices and make a change if want. 

Insurance companies are getting very picky where they offer policies. As a result, consumers had limited choices and are required to pay higher premiums so it is important to review your choices carefully. 

In closing, I urge everyone to stay informed and up to date on what is happening in healthcare. It is important time and your voice is important.

I plan to stay informed on the changes taking place regarding healthcare insurance on the local and the national level. As an experienced healthcare professional who has gone through the process, I have a good number of suggestions to share that would improve the process. I have sent ideas for improvements to the State of Florida Insurance Commissioner, my State Legislative officials and my members of Congress and the Senate. 

Thank you for reading this week’s post in Nurse Advocate. I hope this post provides you with information can use if you find insurance for yourself, a family member or a friend, who find themselves in a position of needing to find a health care insurance policy.

If you have a tip you would like to share, please post a comment in the comment section or email at

Have a good week!  

Friday, August 26, 2016

The Waiting Game

The Waiting Game

Did you ever wonder how doctor’s appointments are made? It seems like everyone has the same appointment time but no one's time is honored.  Recently, I had my three-month checkup with my Hematologists. My appointment was made for 9:20 am on a Tuesday. As we were going to Miami, we took a chance and made a second appointment while we were in the area for 11:30 am. We thought this was a safe bet, but unfortunately, our plan was derailed due to a delay in the patient flow clinic schedule.

To ensure we were on time, we left our house at 7:45 am as you never know how the traffic will be going to Miami. Luckily, traffic was light, and we sailed down to Miami arriving at 8:30 am. We registered and went to the 2nd floor where the Oncology/Hematology clinic was located. We were greeted by a familiar face and told that the clinic was closed for renovation, and all patients were being seen across the hall. We took our seats at 8:45 am and I thought we might get seen early, but the waiting room was filled so I started to have my doubts.

As we waited, the nurses were calling people in but as my appointed time came and went, my name was not called.  Time passed, and we waited and waited. At 10:30 the nurse called me. My husband and I started toward the door but stopped us. She said she was just bringing me in to take my vital signs and I would be right out, so my husband could wait till I came out. 

After returning to the waiting room, we continued to wait and were finally called at 11:00 am. The nurse who put us in the room said that the doctor would be in soon. I asked where the Nurse Practitioner was as she usually came in first and did a preliminary interview and got the electronic health record ready for the doctor. The nurse said she is no longer with Dr. L, but he did have a new NP with him which was why things were a little slow. 

The doctor made his way to our room about 20 minutes later. We realized we would be late for our second appointment; so my husband stepped out of the room to call the office and let them know we would be there as soon as possible.  The doctor came in, said hello, examined me and then went to the computer to document his findings.  I could tell he was not up for small talk, so I did not say anything so he could concentrate on what he was doing. Once he finished documenting, he turned to me and asked me how I was and did I have any questions for him. I told him I was doing well. I did have a few questions, and we reviewed them. He answered all my questions, told me he would see me in three months and that I was stable and doing well. I thanked him, and we went to the checkout desk.

As most cancer patients know our check-ups inspire fear, anticipation and a bit of apprehension. As a result, my husband and I are always on edge as we are fearful a problem will pop up. I am thankful that I continue to be blessed with good check-ups, but that little bit of fear is always there.  Waiting adds to fear and anxiety. 

As I sat there, I wondered why people who came after me were going in ahead of me. There seemed to be no rhyme or rhythm to the process. I wondered when I would be called as no one provided an update, the reason for the delay or an estimated time of when I would be taken. I thought how ironic it was that the TV kept playing an infomercial that talked about how the clinic is committed to providing a high level of customer service, but as I sat in the waiting room, I wondered what they meant by high levels of customer service since no one took the time to explain why I was waiting. In my mind, a simple explanation would go a long way in decreasing my anxiety and help me understand the delay.

Most of us know that when we go to a doctor’s office we will have to wait. We bring books, our cell phones and other things to keep us occupied. The frustration mount when the wait times grow longer, and no one tells you why you are waiting or how much longer the wait will be. I actually wrote a blog post on this topic that was called What to do When Waiting. 

Hospitals, clinics, doctors’ offices, and other settings that service patients have to do a better job of keeping their customers updated and informed. Their survival depends on it especially when revenue is based on the outcomes of patient satisfaction surveys.

As a frequent airline passenger, I recall after some horrendous delays where passengers were held on planes for hours instead of letting them deplane, the Department of Transportation put consumer rules into place that limits airline tarmac delays which provided the passenger with protection. Today, if there is a delay on a plane, the pilot comes on the intercom and informs the passengers what is going on and how long they anticipate the delay will be. They do this frequently throughout the delay to keep customers up to date. Although delays are still frustrating, the pilots messages help to keep the passengers up to date on the delays in their flight which decreases passengers anxiety.  

Today, with the focus on improving the patient experience, keeping patients and their caregivers informed and updated regarding delays is something that should be done in every setting.  As a patient, I appreciate information that keeps me updated on delays from the staff who has control over the patient flow. Updates show that the staff values my time and is a show of respect for their customer.  

I hope this post was helpful and provides some food for thought for the providers we depend on for our care. 

Thank you for reading Nurse Advocate. If you have a comment or would like to share your experience that has impacted your life, please note in the comment section.

Have a good week!

Saturday, August 13, 2016

Going for the Gold

This post is short, but I wanted to take the time to recognize the 2016 Olympics!  Every four years, the world comes together to highlight their athletes in various events. My summer favorite events are swimming, diving, gymnastics and track and field. This year, I have watched some of the other events which might not be as popular but are just as exciting. Two that come to mind were badminton and table tennis. I caught two exciting matches in these events and was in awe of the players as they volleyed back and forth with skills that have made them the best in their sport.   

As the world watches the Olympics, we are reminded that hard work, perseverance and talent allow us to excel beyond our expectations. The Games are a reminder to all of us that there is good in the world, and everyone has a chance to win when they work hard and push past what they think they can do. 

As I watched the parade of athletes during the opening night ceremonies, I was impressed how each country sent their athletes to Rio to represent their country in the name of sports. As the list of countries was read, it was evident to me that as a world we are united, and CAN come together to celebrate in peace and spirit.

As the reporters share personal stories on the athletes as part of the coverage, we learned about the challenges many athletes overcome through determination and support of family and friends. As I thought about this, I realize there is a lot of good in our everyday lives. It is is important that we stop and recognize it when it occurs and pay if forward when we can.

To illustrate this, I wanted to share a story a friend shared on an experience she had when she went grocery shopping after work one day. Here is what she shared on Facebook: “I picked up my little lovebug and headed to the grocery store after work. We walked outside after checking out and it was POURING. A little rain never hurt anyone so we decided to make a run for it and leave the cart right there next to the doors soon to return little one was giggling as we ran to the car because rain is funny. I buckled her into the car, planning to drive up to the sidewalk and load the groceries. Just as I was getting into the car, I look up and an elderly man in a suit, who had just finished loading his car,  was walking towards me with our cart...I thanked him as I opened the trunk and we loaded my groceries. He said it had been a long time since his kids were that young, now he had grand-kids, and he hoped someone would help his daughter out in the same situation as he helped me. I thanked him again as I noticed his leather shoes and suit were almost soaked through.”

This story made me think of the many experiences I have had in my life. I realized how lucky I have been to be blessed with a beautiful family, good friends and the ability to have a career that has allowed me to grow personally and professionally.

I hope this post inspires you to think about the experiences you have had in your life and encourages you to do something nice for someone who crosses your path! If you have an experience you would like to share, please share in the comment box or email me directly at

Have a good week and enjoy week two of the Olympics!