Hospitalized 3: Consumer Reports Study

The Consumer Reports National Research Center recently completed a study of what subscribers (13,450) to Consumer Reports had to say about their own or a loved one’s recent hospitalization and what nurses (731 nurses working in patient care areas) reported on their most recent week at work. Responses varied considerably. For example
• While 13% of patients said their care wasn’t coordinated properly, 38% of nurses said that was a problem.
• 4 % of patients said the facility wasn’t clean, compared with 28% of nurses asked a similar question.

In interviews with hospital personnel, including doctors, nurses, social workers, dietitian and hospital pharmacists, suggestions were made about the best ways to get through a hospitalization safely and minimal confusion.

Do your Homework
- Check your health plan for its rules on hospitalization
- Research hospitals on-line
- Ask about a surgeon’s experience with unusual or complex treatments
- Ask about nurse-patient ratios.

Plan for a Smooth Admission
- Know what medications you are taking; write them down and bring them to the hospital
- Keep your regular doctor in the loop
- Understand the hospitalist’s role (A hospitalist, usually an internist or pediatrician, who has received advanced training in the practice of in-hospital medicine. Usually takes over from your regular outside doctor during your stay.)
- Avoid the ER except for genuine medical Emergencies

Avoid Chaotic Care
- Have a friend or relative with you as much as possible during your stay
- Keep a bedside log of tests, treatments, and consultations
- Identify a single individual to coordinate your care, whether a physician, hospital social worker, case manager or patient advocate
- When using the call button, be specific about your needs
- Be respectful to the staff, but don’t hesitate to ask to speak to a nursing supervisor if you feel your needs aren’t being met

Stay vigilant for problems
- Make sure caregivers wash their hands
- Check medications and doses before you take them
- Be insistent if you’re unhappy with your care or don’t understand something

Plan ahead for discharge
- Make sure you understand plans for your patient discharge
- If you’re not satisfied, ask for help from your hospital’s advocate, social worker or case manager
- Insist on medication reconciliation between home and hospital drugs
See your primary care physician within a week of your patient discharge and arrange for him or her to get copies of your hospital records.

Cards/Relax/Family History

While this coming Friday is the National Day of Listening (see Nov. 22 post), since 2004 the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Learning about their family's health history may help ensure a longer, healthier future together. To help families organize their health history, the US Dept. of Health and Human Services has developed a web based tool called My Family Health Portrait

Thanksgiving ushers in the holiday season. For the next six Wednesdays (Take a Break Day), I will be including both “art breaks” (things you can make as presents or for your own enjoyment) as well as ideas for taking a break from the hustle of the season.

Today’s post is all about cards, how to make them or what to do with ones you’ve received. The “relaxation tip” is creating a spa bath at home.

MAKE YOUR OWN CARDS

Postcards: Cheaper to mail than a greeting card, there are a variety of options to consider:
• Premium Postcard A service of the US Post Office, you create a picture postcard on-line, which is then mailed for you. You don’t even have to stamp it.

• Postcards from Your Photographs: There are now a variety of products on the market to help you turn your photographs into post cards.
- The 2 Buds Vintage Postcard Shop offers backings you can peel and stick on your photographs.

- Avery makes a Postcard for various types of printers, so it’s possible to print off a selection of your photographs. Not only can you send them as a greeting card, but you can print off different photographs and give a stack as a present. Most office supply stores, such as Staples, carry Avery postcards.

Potato Printing: A simple project that not only results in beautiful cards, but it can also be used to make T-shirts, napkins etc. Cut a large potato in half, cut out your design, apply paint and start stamping. Simple cookie cutters can be used to cut out the design.

Martha Stewart’s Card Making Center

E-Cards: Here’s an option that requires no postage. There are many free sites.
My Card Maker
Blue Mountain
Funny E-Cards
Care2 E-Cards

MAKING THINGS WITH CARDS
Gift Tags: Or To/Froms as we use to call them, can easily be made by cutting the card into tag size and either taping them to the package, or using a hole punch, string a bit of ribbon through it. Using pinking shears, or other type scissors, gives the tag a fancier look.

Bookmark: Depending on the size of the card and the weight of paper, you can several things:
• cut a 8-inch by 2-inch strip of the card if size and weight permit
• take a strip of cardboard or poster board and cut up the card, gluing it to the board. To make it more durable, cover with contact paper or laminate it.

Create a Gift Box

Ornaments

RELAXATION TIP
Create Your Own Spa Bath

National Day of Listening

This coming Friday, Nov. 27 is National Day of Listening. National Public Radio (NPR) has a website that can provide a number of resources to help you conduct a successful interview. Since this is the day after Thanksgiving, family and friends may still be around and you can take turns interviewing each other.

If you haven't already done so, along with family stories and lore, ask about your family's health history. Make sure the information you gather is available to other members of the family.

Holidays: OVER-DO THE LAUGHTER AND UNDER-DO THE STRESS

The “holiday season” seems to be starting earlier and earlier each year. With the hype of “black Friday,” the day after Thanksgiving and the number one shopping day of the year, already building to a feverous pitch, I thought it might be helpful to dust off a piece I wrote several years ago about coping with the holidays.

While the strains of “Chestnuts roasting on an open fire” may bring a smile to some, for others it makes their skin crawl. Whether you are caring for, or living with, chronic health problems, or have no health problems at all, the holidays, starting with Thanksgiving and running through January 1, can be a reminder that life is now different and old expectations or ideas no longer fit. With limited finances, changes in relationships, to say nothing of the piling snow in your driveway; it’s not surprising that many people become depressed, bored, frustrated, angry, and/or resentful.

For a time of year that is supposed to be about peace, love and good will, we over indulge, have unrealistic expectations, over spend our budget, try to do more than we can realistically do, which ultimately results in a “Holiday Hangover” that can last until Valentine’s Day. With that in mind, here are some tips for a Healthy and Happy Holiday season.

Humor: Being able to laugh will help you get through some of the difficult situations.

Alone: The holidays are about being together. If you need time to yourself, take it. However, if you are feeling lonely, reach out to family, friends, neighbors, your support group, church or social services. Consider volunteering at a community or religious function. Getting involved and helping others can lift your spirits and broaden your social circle. You don't have to be alone.

Pace: Set the pace for what you feel comfortable doing, and what’s important to you. It’s ok to change traditions or let some go. Plan ahead as much as possible. However, if things change, be flexible and “go with the flow.”

Presents: Set a limit on what you can spend and don’t exceed it. Consider reducing the number of presents you need to make or buy by drawing names or holding a Yankee Swap. Give gift certificates of your time, or make special treats that you know people like. If it’s difficult to get out and shop, order from catalogues or on-line. A donation to a non-profit organization, or charitable group, is a gift that will last throughout the year.

Check out the Wednesday posts for things to make that you can give as presents.

Yesterday: “Don’t look back in anger, or ahead in fear, but around in awareness.” James Thurber You can’t change the past, or predict the future, so live in the present.


Health: You’re still in charge of your health care so you need to continue to exercise, take medications as prescribed, and watch what you eat and drink. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks.

Options: No is an option. People will understand if you can't do certain projects or activities. If you say yes only to what you really want to do, you'll avoid feeling resentful and overwhelmed.

Let others do. Reduce stress by asking for help, and accepting it when it’s offered.

Ideal: The ideal holiday is the one you enjoy.

Differences: Try to accept the people in your life as they are, even if they don't live up to your expectations. The holidays are a stressful time for all, so let things slide and wait until after the first of the year for the discussions you’d like to have.

Acknowledge your feelings: It's okay now and then to take time just to cry or express your feelings. You don't have to force yourself to be happy just because it's the holiday season. If you find that you continue to remain sad, anxious, unable to sleep, feel hopeless, or unable to do routine activities, for several weeks, talk to your doctor.

You: Take care of yourself. If you don’t take care of yourself, you can’t take care of others. Find the balance that allows you to be present for those that you love and care about, but not at the expense of harming yourself.

Sleep. Take time to get the rest and relaxation you need. Stay on your schedule so that you do have the energy for the fun and laughter. De stress with a massage, a bubble bath or curling up on the couch with a good book.

Take a Break: Feed the Birds

There is something very soothing and mesmerizing about watching birds up close. At this time of year, putting out food is one way to ensure they’ll be some to see.

As a child, my mother liked to make sure the birds had a Christmas present, so she’d take suet, put it in mesh bag, and hang it in the tree by the dinning room window. My Aunt’s approach was to scatter day old bread in the backyard. One of my favorite summer activities is to watch the birds flock to our yard just after the grass has been cut.

There are a wide array of bird feeders and bird feed. To learn more about the different type of feeders and ways to attract a variety of birds go to Project Feeder Watch

Hospitalized: Take 2

I’ve continued to hear from people about what to do when a friend or family member is hospitalized. There is no doubt that patient advocacy is critical. As for supporting patients in the hospital, I'm for the 24/7 approach. I can't imagine leaving loved one in the hospital alone.

One person wrote of their experience with a family member who has Parkinson’s Disease as well as her own issues following surgery. Sometimes a particular diagnosis requires some extra special attention, and so I have included the comments, eliminating identifying information.

When J was in hospital for extended stays, I found that monitoring his PD (Parkinson’s Disease) medications was extremely important. Often meds are given at the convenience of the pharmacy and the nursing staff, and PD meds in particular have to be administered according to the patient's schedule. The problem is often that every change of nursing staff ( 2 - 3 times a day, and especially on weekends or holidays when there may be brand new people with no experience with this whatsoever) requires constant monitoring. I once gave J his meds from my own supply in the ICU when no one could tell me whether or when he last had his meds, and I knew he had been in the ICU through a complete meds time schedule, not a good situation at all.

Be aware of cognitive changes, changes in behavior, attitude, etc. J experienced severe depression and suicidal behavior in reaction to a new prescription (this was at home) and a severe psychotic reaction to a morphine-derivative painkiller given while he was in the hospital after surgery. No one on the staff seemed to be aware that he was acting very strangely. This is an important point, as you will know what’s normal for the patient and staff wont necessary know.

Be there to help the patient with getting comfortable, changing the bed position, moving pillows, tightening or loosening top sheets, helping with drinking, using the nurse call button. The patient may not be able to do these things or even be aware that there is a problem. When I was recovering from my surgery and was alone, I wanted a walker and was told by the nurse that it would take three days to get a PT evaluation to even discuss getting the walker. I enlisted the aid of a young med student to get the walker, and was out of the hospital two days later, a full day before the scheduled PT evaluation. Help the patient to order food and to eat if necessary. Eating in bed is not easy.

The bottom line is that your patient is one of many to the staff; he is your one responsibility and you are his advocate.

Hospitalized: What Family and Friends can do

Recently, I experienced a situation that prompted me to send the following survey to colleagues and friends “Based on your experiences, as patient, friend, family member, and/or provider, what are the top five things you would list that someone could do to ensure that the inpatient receives the care he or she needs.”

The responses were identical - the number one response was-BE AN ADVOCATE.

From my experience as an inpatient as well as the daughter of one, there must be someone at the bedside to advocate for the patient. If it can't be 24/7, then perhaps shifts can be taken by people who care. I don't know of any other way, given the situation at most hospitals or perhaps all of them. ..I've literally saved the person's life, because no one was around to notice there was an abrupt change…”

Too weak to advocate for myself, the whole process of "saving" me happened only because of the chance timing of a visit from a neighbor(s) -one a retired nurse the other a retired social worker.

My friend and colleague Grace outlined five ways to be an advocate:

1) Be an advocate for the person who is ill. Speak with (polite) authority to his/her medical providers and make it clear what you know the patient needs and what you reasonably expect them to offer.

2) Question procedures and prescriptions, making sure that what the provider is doing is not going to have a detrimental impact on the patient.

3) Explain the patient’s home situation to the doctor so (s)he will prescribe outpatient care and prescription medicines that are realistically affordable for the patient and can actually be realized; it does no good to recommend physical therapy or “third tier” medications if the person can’t afford them or has no access to get treatment.

4) Act as or organize an information conduit so the patient doesn’t have to answer dozens of phone calls from friends asking the same questions over and over again about the state of her/his health. Make sure other family and friends are informed as much as the patient wants them to be and request that calls be limited to encouragement and support instead of asking for daily healthcare updates from the patient. Also, be willing to return calls on behalf of the patient so (s)he isn’t overwhelmed with inquiries when (s)he doesn’t feel up to talking.

5) Offer to take care of some of the daily responsibilities the patient may have at home or organize a group of volunteers to help out: feed the pets, mow the lawn, shovel the snow, take in the mail, do the laundry, clean the house, do whatever makes sense to alleviate the patient’s worrying about what (s)he will find upon coming home.

One respondent noted, Sometimes I've found that people, including close friends and loved ones, can't deal with illness and such. These people feel helpless and family/friend don't even realize that all they need to do is hold the hand of their loved one, who feels so alone, vulnerable and frightened to death.

Several respondents noted the need for possible volunteer programs to help with advocacy. Personally I think this is a huge need - not only in hospital but in outpatient. I have pondered if there might be some way for a group of savvy women to start and advocacy team.

In doing an on-line search, I found that the University of Minnesota’s Taking Charge of your Health has information for the patient and family and friends on ways to help during a hospitalization. Similar to my survey findings, their number one recommendation is to “Have someone with you at all times.”

A tight economy, budget cuts, an aging population and sicker inpatients are causing considerable stress on an already stressed system. As noted in Have Healthy Hospitalizations from the University of Minnesota’s Taking Charge of Your Health While it may seem ironic, hospitals are not necessarily healthy environments. According to a 1999 Institute of Medicine study, as many as 98,000 people die each year due to medical errors.

Therefore to help your family for friend obtain the best possible care, be an advocate, use Grace’s tips above and/or those offered by the University of Minnesota’s Health Hospitalizations.

If you are not able to be with a friend or family member, the patient and/or their designee, should check with the hospital to see if they have a program where a volunteer can sit with them.

I know that several people have said they’ve tried to join the blog but weren’t able to do so. Please don’t hesitate to e-mail margoc@tds.net me directly with your comments and suggestions.

AAD Guidelines on Vitamin D, Sun Exposure, Sunscreen

Dermatologists Can Help Separate Fact From Fiction for Sun Exposure, Sunscreen and Vitamin D

American Academy of Dermatology Increases Minimum Sunscreen Recommendation from SPF 15 to SPF 30
NEW YORK (Nov 10, 2009) — When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production – particularly when enriched foods and supplements are safe and effective sources of this vitamin.

Speaking today at the American Academy of Dermatology’s SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy’s increased recommendation on the minimum Sun Protection.

Factor (SPF) of sunscreen.
“Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production,” said Dr. Tanzi. “The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal.”

Myth: Sun exposure is the best source of vitamin D.
Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.

While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.

“Although studies showing the benefits of increased vitamin D intake have caused some to propose ‘sensible sun exposure’ or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer,” said Dr. Tanzi. “UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure – especially in relation to vitamin D.”

Myth: All sunscreens are created equal.
While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun’s burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product’s ability to deflect the sun’s burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.

“SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays,” said Dr. Tanzi. “The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective.”

Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.

For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.

Myth: Using a higher SPF will ensure you don’t burn.
Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors – including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.

Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.

“For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating,” said Dr. Tanzi. “Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. ”

To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.

• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.

• Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.

• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Check the Academy’s Web site for the latest list of sun protective products that meet the stringent, evidence-based criteria of the AAD SEAL OF RECOGNITION®.

For more information about skin cancer, please visit the “SkinCancerNet”, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

Take a Break: Play Moon, Fish, Ocean

Play the Zen version of Rock, Paper Scissors , called Moon, Fish, Ocean

The author of this site, Craig Conley, has another site called Follow Your Bliss Compass Those three little words by the great mythologist Joseph Campbell teach a profound lesson in tapping the energy that makes you tick. But how to begin? Start using the Follow Your Bliss Compass to put yourself on the right track. You'll soon start becoming mindful of the blissful energy within you and will begin using it to make empowering changes in your life. Following your bliss is always a real adventure—a journey into the uncharted center of yourself.

You’re in Charge/Shared Decision Making

The health care system is shifting to “patient centered care,” which puts the patient and those closest to them, at the head of the health care team. Depending on your situation, this can be a complicated maze, which seems to have no end. Fortunately, hospitals and medical centers are recognizing the need to provide patients with tools to help them. One such program is the University of Minnesota’s Center for Spirituality and Healing’s “Taking Charge of Your Health" Within the site are excellent resources including: “Navigate the Healthcare System.”

Dr. Carolyn Clancy, a director for the Agency for Healthcare Research and Quality, has an advice column, with brief and easy to understand responses to many issues, such as Open enrollment-what to consider when choosing a health plan.

There are a variety of other on-line resources, including
• Bravewell Collaborative Navigating the Healthcare System

• Revolution Health Navigating the Healthcare System

• Excerpts from our Bodies, Ourselves: Navigating the Health Care System

Shared Decision Making
In most fairy tales, there generally comes a point where the hero has to make a very important decision. Do I take a right or left at the fork in the road? Is it a toad or a prince disguised as one? Frequently, the hero or heroine has a trusty fairy godmother, or a special device to help them make that decision.

When it comes to managing our health, there are many decisions that must be made. Should I try a particular type of treatment? Is surgery my best option? Maybe it’s time to stop treatment? So where’s your fairy godmother when you need her?

Pioneered at the Dartmouth Hitchcock Medical Center, hospitals are now starting to offer “Shared Decision” programs. Working with a staff member of the program, and/or using some simple tools, decision making becomes a lot easier. Check with your doctor, case manager, or social worker to see if one is offered where you receive care. There are also a number of excellent websites on-line to help as well.

• The Ottawa Decision Guide make decisions, plan next steps and monitor their progress. The tool can be used for making any type of decision.

• Decision Aids by Health Topic

• Decision Aid Library

• Informed Medical Decisions

Take an Art Break: Make a 3-D Snowflake

There is snow in the mountains where I live, so this is as good a day as any to learn how to make 3-D snowflakes. Go to http://www.wikihow.com/Make-a-3D-Paper-Snowflake for step-by -step instructions. I’ve been making them for years and have taught first graders as well as grandmothers how to do it. The final result can be enhanced with spray glitter and be the star on a Christmas tree.

In the winter, I work at the local ski resort’s First Aid room. One of the first activities we do is make the snowflakes and decorate the room for patients. Not only do we receive many compliments all winter long, but we’ve taught more than one injured skier how to make them as they recuperate.

Chronically Ill May Be Happier If They Give Up Hope

ScienceDaily (Nov. 2, 2009) — Holding on to hope may not make patients happier as they deal with chronic illness or diseases, according to a new study by University of Michigan Health System researchers.

"Hope is an important part of happiness," said Peter A. Ubel, M.D., director of the U-M Center for Behavioral and Decision Sciences in Medicine and one of the authors of the happily hopeless study, "but there's a dark side of hope. Sometimes, if hope makes people put off getting on with their life, it can get in the way of happiness."

The results showed that people do not adapt well to situations if they are believed to be short-term. Ubel and his co-authors -- both from U-M and Carnegie Mellon University -- studied patients who had new colostomies: their colons were removed and they had to have bowel movements in a pouch that lies outside their body.

At the time they received their colostomy, some patients were told that the colostomy was reversible -- that they would undergo a second operation to reconnect their bowels after several months. Others were told that the colostomy was permanent and that they would never have normal bowel function again. The second group -- the one without hope -- reported being happier over the next six months than those with reversible colostomies.

"We think they were happier because they got on with their lives. They realized the cards they were dealt, and recognized that they had no choice but to play with those cards," says Ubel, who is also a professor in the Department of Internal Medicine.
"The other group was waiting for their colostomy to be reversed," he added. "They contrasted their current life with the life they hoped to lead, and didn't make the best of their current situation."

The research was published in this month's edition of Health Psychology.

Ubel was joined in the research by Dylan M. Smith, Ph.D., a research specialist at the Ann Arbor VA Health Services Research and Development Center and a U-M psychologist; Aleksandra Jankovic, of U-M's Center for Behavioral and Decision Sciences in Medicine and George Loewenstein, professor in the Department of Social and Decision Sciences at Carnegie Mellon University.

Loewenstein said these results also may explain why people who lose a spouse to death often recover better emotionally over time than those who get divorced.

"If your husband or wife dies, you have closure. There aren't any lingering possibilities for reconciliation," Loewenstein said.
Ubel said health professionals find it easier to deliver optimistic news to patients even when they believe the prognosis is unfavorable, justifying it by assuming that holding on to hope was better for the patient.

Said Loewenstein: "It may be easier for a doctor to deliver a hopeful message to a patient, even when there isn't much objective reason for hope, but it may not be best for the patient."

"Hopeful messages may not be in the best interests of the patient and may interfere with the patient's emotional adaptation," Ubel says. "I don't think we should take hope away. But I think we have to be careful about building up people's hope so much that they put off living their lives."

The research was funded by the National Institute on Child Health and Human Development. Smith was supported by a career development award from the Department of Veterans Affairs.

University of Michigan Health System (2009, November 2). Chronically Ill May Be Happier If They Give Up Hope. ScienceDaily. Retrieved November 3, 2009, from http://www.sciencedaily.com_ /releases/2009/11/091102085827.htm