At the recent Coalition for Compassionate Care 2016 Annual Summit in Newport Beach, we heard a presentation from E- Patient Dave, which related his challenging experience navigating the medical care system to receive the care that he thought was appropriate for his stage 4 renal cell carcinoma.

As I heard his presentation, I thought of the old adage that we learn more medicine from our patients than from our text books because “diseases don’t read textbooks”.  This was true in my own experience overseeing the care of my mother with vascular and Alzheimer dementia as well as my father-in-law with vascular dementia and refractory LBP.

The uncomfortable truth at the root cause of antibiotic resistance is the huge numbers of people receiving antibiotics for infections they do not actually have.  A ready example is the persistent widespread practice of prescribing antibiotics for asymptomatic bacteriuria. However the problem is actually much larger if an audit is conducted of actual prescribing practices in any given skilled facility.

An innovative stewardship protocol has been achieving significant early results in a pilot program begun in 2015. The protocol won a best-practice award at CALTCM 2016 in April. The protocol is aimed directly at altering:

A fascinating chain of events has unfolded  over the last few weeks regarding capacity determination of the billionaire Mr. Redstone. Personal details that usually are kept in the privacy of a person or family have hit the news headlines. The issue at the core of this story has been determination of one’s capacity to make decisions that is then used in a court of law to determine competence. In this case there were several legal issues happening in tandem, which I will not attempt to analyze, but suffice it to say that some parties were interested in Mr. Redstone being declared competent to make certain decisions, while the other parties’ interest leaned the opposite way.

On June 9, End of Life Option Act becomes an option in California in all settings of care.  What will your facility do when it receives a request for this option?  I predict that most of our facilities will be receiving such requests in the coming months.  How will your facility manage those requests?

Fortunately, the larger settings of care are developing tools and resources for us to consider so that we can develop appropriate, standardized, impartial, and systematic responses to these requests that represent the interests of our patients, families, staff, management, and ownership.