Including Families and Caregivers

"What would you like your family to know?"

Family and informal caregivers play an important role in the lives of their loved ones. They also play an increasingly important role in how the health care system functions. By communicating effectively with all the individuals involved in your patient's care, you can help him or her while making efficient use of time and resources. Informal caregivers may be important "informants." They can also help to reinforce the importance of information you give or the treatment you prescribe. When a companion is present, be aware of communication issues that arise in three-party interactions. Too often, the conversation may be directed at the companion and not at the patient; in some cases, the encounter can become a "two against one" match, which no one really wins. Whenever possible, try to sit so that you form a triangle and can address both the patient and companion face-to-face.

To protect and honor patient privacy, be sure to check with the patient on how he or she sees the companion's role. In many cases, the caregiver or companion can be a facilitator, helping the patient express concerns and reinforcing what you say. But it is best not to assume that a companion should be included in the medical encounter. First, check with the patient. Conducting the physical exam alone protects the patient's privacy and allows you to raise sensitive issues. The best time to conduct a "mini-mental" exam is during a private exam, so that a family member cannot answer questions or cover for the patient's cognitive lapses.

Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairments. If a family member has been named the health care agent or proxy, under some circumstances, he or she has the legal authority to make care decisions. However, without this authority, the patient must make his or her own choices. Try to set clear boundaries with family members, and encourage others to respect them.
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Deconstructing the Digital Era

Senator Ted Stevens thinks the internet is a "series of tubes." George W. Bush believes there are internets galore out there. And John McCain...well, the Senator has admitted that he doesn't even know how to use a computer. Politics in the digital era is tricky, not so much because of the wealth of information on the web, but because of the millions of ordinary Americans using that information on a daily basis. Armed with new media tools, muckrackers today number in the millions. No longer is a candidate able to present a poll-tested package to the press and have that persona spoon-fed to the American people. No, today's voters have available to them a universe of information consisting of detailed voting records, primary sources, debunking sites, blogs, and more.
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Continuing Care Retirement Communities (CCRC)

Continuing Care Retirement Communities (CCRCs) are also referred to as life care communities. Entering one is usually a once-in-a-lifetime choice and that's the appeal. Many have large campuses that include separate housing for those who live very independently, assisted living facilities that offer more support, and nursing homes for those needing skilled nursing care. With all on the same grounds, people who are relatively active, as well as those who have serious physical and mental disabilities, all live nearby. Residents then move from one housing choice to another as their needs change.
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You Are Already Consuming Cloned Animal Products

Are food products from clones labeled? I'm afraid not. The FDA feels that any additional measures relating to food derived from adult clones and their offspring, including labeling, is not necessary. They claim that there is no science-based reason to use labels to distinguish between milk derived from clones and that from conventional animals. What do you think about that?
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Federal Whistleblower Protection in Jeopardy

Special Counsel Scott Bloch, appointed by President Bush in 2004, is overseeing the virtual elimination of federal whistleblower rights in the U.S. government.The U.S. Office of Special Counsel (OSC), the agency that is supposed to protect federal employees who blow the whistle on waste, fraud, and abuse is dismissing hundreds of cases while advancing almost none. According to the Annual Report for 2004 (which was not released until the end of first quarter fiscal year 2006) less than 1.5 percent of whistleblower claims were referred for investigation while more than 1000 reports were closed before they were even opened. Only eight claims were found to be substantiated, and one of those included the theft of a desk, while another included attendance violations. Favorable outcomes have declined 24 percent overall, and this is all in the first year that the new special counsel, Scott Bloch, has been in office.
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