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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Big Media Is In Control

Big isn't always bad -- unless you're talking about the companies that dominate our country's media. A handful of companies control most of what we see, hear and read every day. They own our TV stations, radio stations, newspapers, magazines, cable channels, movie studios, music labels -- even our favorite Internet sites. Unchecked consolidation means that Big Media are getting even bigger, giving these firms more control over our news and information. Bottom line? Big Media are bad news -- for all of us.
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Upper GI Series

The upper gastrointestinal (GI) series uses x rays to diagnose problems in the esophagus, stomach, and duodenum (first part of the small intestine). It may also be used to examine the small intestine. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working.
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Warning Signs That 401(k) Contributions Are Being Misused

Increasingly employees are asked to make voluntary or mandatory contributions to pension and other benefit plans. This is particularly true for 401(k) savings plans. These plans allow you to deduct from your paycheck a portion of pretax income every year, invest it and pay no taxes on those contributions until the money is withdrawn at retirement. Is your plan being misused?
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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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