Due to the many kinds of digital technologies that have been developed over the years, the healthcare industry’s future is really changing before our eyes. Since Baby Boomers are entering retirement age, how will they benefit from digital healthcare? Does it make things more simple or complicated for them? Once again, the Booms Day Prepping panelists come together and share their thoughts on the technological changes of modern healthcare.
Wayne Bucklar: You’re listening to Booms Day Prepping, our regular look at what life’s like for the Baby Boomers and what we need to do for that next stage in our lives. We’re joined as always by our panel, we have with us Brian Hinselwood, Bron Williams, Amanda Lambros and Glenn Capelli and my co-host is Dr. Drew Dwyer. Now Drew, can you lead us off on this being a practicing clinician?
Dr. Drew Dwyer: Yes, this is good. This is a favorite subject of mine contemporaneously. Probably over the last six months, I seem to be discussing the technological changes in healthcare, it’s big on the agenda. And last week, I had the privilege of being a Chair at the Australian Healthcare Week and My Healthcare Record, e-nursing electronic documentation and of course, the new established role for clinicians who are called Clinical or Digital Statisticians or Clinical Statisticians who are clinicians who operate in an electronic record or electronic database area is I find fascinating as we progress towards a modern and contemporary society that is using more digital information in a more smarter way and we’re using more devices. I think it’s important to raise this subject in our discussion, I think so that our listeners can understand this is something that will be placed in front of you on a regular basis and specifically about our attraction, or distraction, or aversion and barrier to getting an eHealth record or having our privacy and the privacy of our medical and health records placed into the cloud or into the internet so that health professionals and people that we consult with have access to our records when they need them. I love this subject, I’m sure it will bring different debate to the panel but for me, I’m sort of still sitting with splinters in my backside because as a person who would love the access to this information around my older clients, this is an excellent idea particularly because I deal with a lot of people who have cognitive deficit, they’re aging, they can’t remember a lot of their histories and medical histories, they will know certain parts. There are certain parts of their medical histories that they do not share with their loved ones or close relatives and of course probably, 8 out of 10 times I am stuck dealing with a person of concern who has an EPOA or somebody making decisions as an advocate or an important person in their life and they really don’t have access or understand the information that we’re looking at from a clinical diagnosis or a data perspective.
Wayne: Now Drew, just tell us what an EPOA is please.
Dr. Drew: An EPOA is an “Executive or Enduring Power of Attorney” depending on where you come from. But basically, we have two areas – “Power of Attorney and EPOA or Executive or Enduring Power of Attorney.” Now I often explain this in a layman’s term. Power of Attorney is simply means “the voice of a person.” So let’s say I’m 90 but I’m getting forgetful, I’m not keeping records very well but I’ve still got my cognition and I know what I want. However, I can’t be bothered telling the same thing to everybody over, and over and over. So I choose a person to be my power of attorney. Basically, they become my voice and advocate, they talk to me, they understand me I give them the answers that I want to give everybody else. And when it comes to time to talking to others and advocating or speaking up for me, it’s my power of attorney that people go to so that I don’t have to be bothered with answering questions all the time and getting confused because I do have my cognition and capacity and I do understand what I need to say is that it gets tiring and awesome when you’re so old and I can’t remember everything every minute and every detail. However if I lose capacity and if I’m unable to hold my cognitive thoughts and capacity around issues, but I have managed to get these things out to a power of attorney or down in writing, I then rely on the legal position over enduring or an executive power of attorney, an EPOA and that person then becomes my choice. That person understands me so well that if a decision needs to be made around my healthcare or finances, that person already has my legal written right through lawyers to make the choice for me. So a power of attorney is simply the voice and advocacy of the person. The enduring or executive power of attorney, the EPOA is the legal choice and decision maker of the individual and that’s the difference between the two.
Wayne: Now we’ve got that nailed down. Let me take you back to where I interrupted you.
Dr. Drew: Okay. So for me as a clinician, I love the concept of having access to medical records easy, and accessible and obtainable to get the information I require to make the clinical decisions from the heuristics that we know. Heuristics of course is known information, evidence-based information, data. The splinter that sits in left cheek of my bum from the fence is specifically around security of information, who gets my information? and what happens to my information in regards to privacy? Now once you get up to the age of being sick, and chronic and very unwell or in the case of an emergency and a life-threatening situation, I personally don’t give a stuff about privacy, I want someone to fix me, help me, guide me or complete the process. So I think that’s where the discussion starts. Members of the panel, what do you think of ehealth record concept and do you have the same splinters in your bum that I have?
Bron Williams: I don’t have any huge issue around privacy. I think people know more about me through Facebook than through medical reports and maybe it’s because I’m genuine.
Wayne: They certainly do now Bron.
Bron: Yes. But I don’t understand because I don’t have an issue around privacy for myself like I have my own medical conditions and I don’t see that I need to keep those private from everybody else if that’s going to be a benefit to me. That’s how I view it that if my medical records are out there for medical people to access, that’s fantastic. But look if anybody else wants to have a look at my medical data, go right ahead if it makes you happy.
Amanda Lambros: But I think Bron what you’re doing is you’re saying that from a really open space and a lot of people are not in that open space and a lot of people, they might want to hide, they might have found out that they had certain STIs as a younger person or as a teenager and when it comes to their records as an older person where it’s actually going to be quite useful for their medical care, they don’t want anyone to know about that because it was taboo.
Dr. Drew: Perhaps, if they’re a woman.
Amanda: Exactly, and they just don’t want people to know about that. On one hand hand you’re going “Well, I don’t care who knows about it as long as it’s gonna provide me with good outcomes of care.” When other people are terrified to let anybody know what’s in their medical past.
Glenn Capelli: Are there other situations where you can choose certain information goes out to everyone and certain information goes to certain folk or have access to it? And can we trust just technology around that given I mean one of my favorite acronyms in life is “PICNIC” – Problem In Chair Not In Computer.” That sometimes, do you really trust the human beings that are entering the data etc.? “Once jotted forever slotted” so that information of what you did when you were 16 years of age now being held against you in job interviews or whatever because it’s public knowledge. So is that kind of flexibility there Drew and that you can allow to everyone some things go to everyone, some things are very privacy protected?
Dr. Drew: Yes, good question Glenn. At the moment from my understanding and particularly coming from this last conference, and chairing and meeting these different clinicians and their expertise, what they call themselves again is “Clinical Informaticians.” So they have the same concepts or the same concerns. It is one, the evidence or the quality of the data that’s been placed into the system and how that data sits in the system. Two, it’s what is being taken out, and analyzed and put into a board or a dashboard for that data, how do we recognize the data and its significance? And three, the other thing is the ability for an individual if say for example, I only want information to do with my certain parts of my healthcare to go to my physician. However, my psychologists can have other information and not information that’s more clinical. But as a clinician myself, I can’t differentiate. We now work in a platform of best practice where we understand interdisciplinary communication. So it is important that we understand that all the other disciplines or multi disciplines that approach us in care, many hands onto one heart. It’s important for say me as a nurse to understand the same things that a counselor like Amanda would want to understand because they actually interrelate and overlap and it’s easier then for Amanda and I to communicate as clinicians and how we’re going to provide their support to the client because we’re collaborating together and not overlapping each other’s partners or building a conflict in the pathways we want to take. So you did right Glenn and there are apps being developed at the moment and it’s all come down to apps where people are given the options of what they share and who they share. But currently and I’m only talking in Australia, currently in Australia, the law is being changed and as we continue to step through the “My Healthcare Record” as a national government funded program, it used to be an opt-in and as of this year, it will become an opt-out. So everyone in Australia will get a My Healthcare Record and it will be a case for individuals now to opt out of that information sharing rather than to opt in. So I think that’s something that’s significant that needs to be shared to the community and everyone needs to understand. When you’re talking about your electronic healthcare record, it’s now an opt-out as far as the government’s concerned. And if you haven’t ticked the box that says “I don’t want my information shared” – it’s going to be shared.
Brian Hinselwood: I find this stuff a little bit strange because in this day and age with computers that record everything, every website you go on, you just had this whole thing with Zuckerberg with his Facebook thing. There is nothing that we do on computer anymore that is private – end of story. I’ve just had a very minor medical procedure and for far I’ve had cataract removed. Now this was done over a two-week period and when you go in the first week and now, it was to the same clinicians, the same doctors, the same everybody, they ask you a whole pile of questions which they tick various bits on various forms. And they ask you every illness you’ve ever had, every tablet you ever taken, the whole thing you go through, “Anything, okay? Fine.” So they do that and you go back the next week, exactly the same procedure and I think, “I just went through this, seven days ago. Surely, you can just keep that copy.” I mean unless something like I’ve had some dreadful thing happen within the seven days in which case you probably wouldn’t be there. So getting the electronic base with everything on it would be “Click on There” and “Oh, is this all still relevant?” It’s much easier than going through, “Yes, well I take this tablet for that and I do this for that.” I find it amazing that we’re not further down the road I think.
Wayne: We need to sort out a bit of terminology here. The federal government funded My Health Record is not the only health record that we need to deal with. Most of the state-funded hospital systems now have electronic health records as well and there is of course Medicare which exists separately to the My Health Record which also records a whole bunch of data. And then of course there is the practice records that all the GPS keep in addition to that and the private hospital records. So one of the problems that we have Brian and it comes back to your point about why do you get asked these questions and the answer is that there is a medical legal risk for the clinicians who are treating you currently and they don’t trust the electronic records that are available to them. Similarly, were they to rely on the electronic records that are available to them, they would need to review the last 70 years of your electronic health record in order to be confident they hadn’t missed anything and that would take longer than your entire procedure. So it’s not as simple as, “Isn’t it wonderful, I’ve got all this information?”
Brian: But is that going to change when we go on electronic records? Surely my local GP is going to have the same problem or be it the government is now running or something or other? I mean it just seems to be adding another layer to a multi-layered system.
Wayne: I don’t think anyone in the world yet has a system that you would hold up as being correct, or perfect or adequate.
Dr. Drew: I’d like to interject with something here. If you understand the breakdown of the current statistics around electronic healthcare records, what’s so easy to understand or easy for us to discuss perhaps for our Boomer listeners is that currently, 40% of people or Millennials are placing and taking up the records. The middle-aged or the X-generation people about 25% and 60 years older and above the Boomers more or less only 12% to 14%. So for me, that statistic tells a lot of things. The older generations of people that we’re talking to thru is this listening channel and this very reluctant and have the much resistance in doing this and releasing information, there’s some messages in there. Whereas the X-generation not so uncomfortable with it – yes release, release, release. The younger Millennials “shuck it up, who cares? Put it up. They can see me in Facebook, and Instagram and Snapchat and blah, blah, blah” and they’re not interested in the privacy issues, they’re share, share, share. I don’t know what you think but that’s what I get out of that data.
Wayne: The other side of that data is what percentage of doctors are contributing to the scheme because in fact, patients don’t put anything up, they don’t allow it to be put up.
Dr. Drew: Most of it’s coming from general practice Wayne.
Wayne: Well I’m not even sure about that Drew because most of the hospitals have bilateral agreements with the Commonwealth and have automatic feeds into it. So the hospitals are automatically feeding it in. The GPs, I’m not sure what the current status for how many are doing it.
Dr. Drew: Six thousand three hundred and thirty five.
Wayne: Out of how many hundred thousand doctors?
Dr. Drew: Oh yes, I don’t know, I couldn’t tell it at the top of my head. Hospitals in Australia are only 799 but I don’t know how many hospitals we have.
Wayne: And Amanda, are you contributing in your practice?
Amanda: No. So counselors aren’t allowed to contribute in Australia. Clinical psychologists are but counselors aren’t because we’re not part of the opera system. So we have an alternative healthcare practice system. So if you’re a psychologist, a social worker, occupational therapists, people like that, if they’re registered under that.
Dr. Drew: I can as a gerontologist. So you can.
Wayne: But do you Drew?
Dr. Drew: Of course I do. I mean as anyone who doesn’t know, I also have a business where I employ GPs and nurses in my business and we have a system called “Medical Director.” Inside Medical Director is where we keep all our records of our patients as the doctors and nurses see them and of course, everything that we do now there’s a button we click and it uploads to My Healthcare Record for that individual.
Wayne: Now who owns that record, the patient, or the GP or the practice?
Dr. Drew: Actually the practice owns it. The GP co-owns it and has access to the data at any time. The responsibility by law is in two areas up to the general practitioner or the nurse.
Wayne: And after those GPs move onto other practices?
Dr. Drew: The practice holds the information.
Amanda: The practice holds it.
Bron: So where does a client, the patient sit with legal access to their own information?
Dr. Drew: No. But I need to explain something because this is something that comes up regularly, under PPE or PPP, the Privacy Principles, a client can ask immediately for access to their records, no problems. What they can’t do is take a copy of the record or take the record away unless it suits the practitioner or the business to allow them to do so under medico-legal reasons. However, they can view and see the record in front of the clinician, the practitioner or the business manager. But it is unfortunately they’re not allowed to change it, scribe onto it or take it away unless they’ve been given permission to do so.
Bron: I think that’s probably one of my concern.
Brian: What happens if somebody moves from one end of the country to the other?
Dr. Drew: Within the GP, the new GP asks the other GP for a copy of the record and it’s about consensus or right to know, right of passage to know. So if one of my GP sees a patient, they move to Perth and when they get over to Perth, their GP sends us a letter and says, “Can I have all Mrs. Jones’ records?” Generally, the GP goes, “Yep, you’re GP Bob, I’m GP Joe. No problems, here’s her records.” Because it’s from GP to GP, it’s a medico-legal issue, we’re quite happy to transfer that information to that other GP practice. When it’s a client who comes in and says, “I want to see my healthcare record and I want to see what you wrote on me on that day.” They read it and they’re not happy with it, or they want it changed, or they don’t want that information, this happens in a lot of nursing homes by the way. They can read the records, see the transparency but when we understand there may be a lead medico legal issue sitting around that record, we don’t have to release that record to the person. They can apply through the courts to get it and then we have to comply but if we believe there’s a medical, or legal position, or litigious issue to sit around, we don’t by law have to release it. But what we can do as a general consensus has allowed the person because of transparency particularly in my business, allow the person to read the transparent document to understand it, to have a communication about it. But if they want to take it away and use it or keep it, not so much. But we’ve got now issues like for example when a client has a blood test, we give them the blood tests. Because there’s really nothing in that blood test to be afraid of, it’s transparent information.
Bron: So you’re mentioning like legal issues and certainly I’m not casting any aspersions on you Drew as a practitioner. But we do know like there have been medical and legal cases where doctors have been sued and rightfully sued for malpractice on a variety of different levels. How much does this inability of a patient to be able to take away their records and people have a copy of them for themselves make it easier for an unethical doctor to hide things that could and should be brought to light?
Dr. Drew: Well at the end of the day Bron, it’s like this. Human beings are assholes. So we can sit and make judgment.
Bron: You are so complementary Drew.
Dr. Drew: You’re very welcome. We can sit and make comment on it all day but it’s no different. I mean for me, it’s about a personal issue – ethical practice, your standards of registration, your compliance to your board of regulation and of course, that’s why we have risks with unregulated healthcare people. And Amanda, please be happy to speak. This is why counselors and I’m also a counselor – in our unregulated zone, we are always trying to apply the ethical standards provided by the Board because we want to show and prove to the board that in counseling, we are as ethical, and regulated and professional as others. However, there have been a number of people in the counseling domain that are being in this very unprofessional, very unethical and they’ve destroyed or holding back the opportunity for that individual person who’s a counselor, a therapist,a psychotherapist, anything like that – to achieve recognition in a National Standards of Board. At the end of the day when it comes down to it, if somebody does wrong and they’re registered, I can guarantee you, they’re gonna get sued and the Board is gonna hold them out. Amanda?
Amanda: I totally agree with that and I think unfortunately, because as counselors we’re an unregulated system in Australia at the moment, pretty much anyone can put up a sign to say that they’re a counselor.
Dr. Drew: And then start dealing with mental health issues which is appalling.
Amanda: Exactly. And unfortunately, I don’t think that enough of society especially in Australia is aware of that. In other countries, you have to have degrees, or masters or even a PhD in order to practice. Whereas Bron, if you’ve never even done a mental health unit, you can put up a sign on your door that says, “I’m a Counselor,” advertise, create a website and people can come to you.
Dr. Drew: And there are many who do it.
Amanda: And there are many who do it because most people are in such a vulnerable state that when the time comes that they’re actually seeking out your services, they’re not asking, “Oh by the way, can I see your qualifications? Where’s your degree from?” They’re not asking that stuff. So even though there’s a wide spectrum of people who are completely uneducated in the topic yet still calling themselves counselors and then there’s other people who have masters and PhDs in the topic of counseling, they’ve kind of shoved everyone into the same thing and said, “Well, you’re unregistered so we can’t deal with you. You’re not on the system.”
Wayne: We might reserve the registration of various professions for another episode and see if we can move back to our issues around electronic health records.
Amanda: I kind of want to make a mention here because Drew what you said I think it’s really interesting because when I log into like (an app) which is available to anyone in Australia to login, you create your own account, log in. I can see my health record, I can see my kids’ health records, I can see every test they’ve ever had, I can pull up all their results, their images, their everything.
Dr. Drew: That’s because you find a way for it to be there Amanda. So that’s the whole issue, like for example if in a nursing home and if I have a disgruntled loved one come and approach us with a conflict resolution, generally one of the first things I’ll ask to see is their healthcare record on their loved one. For me, absolutely transparency, put it on the table. The issue is held by what we know. You see law is high cultured and low cultured and people don’t understand this concept very well. And I’d be interested in Glenn’s input when I finish saying this. But high cultured information is very much around law. So when we look at high culture, we look at for example, we were in a court case with one of these fellows from a current affair that you see that’s ripping off the elderly and their money and blah, blah, blah, blah, blah and where our lawyers are in front of the judge going. “This man has got a history of this, he’s a blah, blah, blah, this is where he’s done it a hundred times before. This is who he is, he’s a criminal, and a charlatan and a scammer.” The judge will say, “Stop, I’m not interested in his history or past. I’m interested in A-B-C-D, Legal Steps 1, 2 and 3 because this is the low culture of law.” Law is quite pragmatic-systematic and sits in a framework and it won’t allow the emotional unbalance of someone’s opinion of someone else, a story, a recording, tape recording, a book, a letter, a note. It will not have miss this stuff or it will dismiss it. If it’s going to cloud the low cultured process of law litigation in a step around a particular case. So people get quite angry, confused over this but that’s the same process. When you are sitting in healthcare record zone, you’ve got to look at high and low cultured aspects. If I have a disgruntled loved one who you can feel very quickly is after or on a mission, I’m happy to disclose the record but I’m not happy for them to take that record away or to be left alone with that record to damage it, transcribe it or to make a change to it. I’m not happy for them to take photos of the record and move it away unless of course it’s a record I go, “Sure, let me photocopy it. I’ll give it to you.” Or “Sure, take a photo of it here it is.” But when there’s a litigious issue, we have the right under law to protect everyone in the organization, all registered and unregistered people to be able to go, “Hang on a moment, we need to protect all people here.” And it’s not just because it’s their mother’s record or their record that they have the right to take it or to use it or to do what they like with it. But in your case here looking at the My Healthcare Record, you’ve signed away and so of course, you can get access straight away. And then as I said, this is one of the splinters in my bum. I like that idea, some people don’t.
Glenn: And so it’s interesting for me because I think in all our life, it’s a working relationship, working relationship with God or the universe, working with technology and we got to do our 50%, it’s a 50/50 thing. So I would hope that all human beings develop an ethos in life where they’re going to a counselor, they’re asking the questions beforehand, “Who is this person?” If you’re gonna build a house, build it with a master builder, that’s part of the Master Builders Association so you’ve got coverage and insurance coverage. If you’re gonna hire a speaker, get a CSP, a Certified Speaking Professional. So know that people have got the place and it is a working relationship, it means we’ve got to ask questions. So I always figure that the most important health records I keep are two – one is the health records I keep for myself, on myself. My Fitbit data for me has been the major health revolution for me in the last 10 years. I know what I need to be walking? I know what my weight is, I’m getting the feedback on that and I’m acting on that feedback.
Dr. Drew: On your hydration and stuff.
Glenn: Yes. And lot of the folks who need that the most though, we’d buy them a Fitbit and they go, “Oh geez, why would I want to know this? I don’t want to know the data.” But I think we’ve got to know the data. And so the working relationship keep your own health records, notice if you’re eating certain foods that they affect you in a certain way. Yes, we’ve got health professionals but we should be able to be our own asshole and we’re a nice asshole. The second health record I like to keep is a jukebox. So when I thought we were talking about health records, I was thinking of songs. I’m thinking of the health record on my jukebox. We’ve already got “Private Dancer” by Tina Turner with a “Little Help From My Friends” by the Beatles, you’ve got to have a teamwork around you and perhaps, a little bit of “I Will Survive” by Gloria Gaynor and to be able to keep on going. But ultimately, I would run with the health song of “Man in the Mirror.” Michael Jackson wrote a beautiful song but he didn’t look in the mirror himself. And one of the tests that I do is when I’m looking at that man in the mirror, I put a little bit of Van Halen on and I do a jump. And if I jump up and down and the rest of my body doesn’t stop moving for another two minutes or three minutes, I need to look at my health and look at my weight and look at my fat distribution. So as much as we can have all of the records you like, the most important ones are the ones you keep it to yourself and how you respond to them and actually working on feedback constantly yourself.
Dr. Drew: I mean I think it’s important that this discussion’s had as I said, look at the statistics we’ll see many of the older generations or the Boomer generation above are not partaking in this at all because of I have no doubt fear or knowledge. But the next step which has already begun and I’d be interested to hear everyone’s comment on this is they’re now contemplating, putting a chip under our skin. A nanotechnology that clinicians will be able to pull data much like your Fitbit Glenn and my Fitbit, I’m wearing one right now, you can see. But where this computer chip and the nanotechnology in it will be able to give us recordings of temperature, blood pressure and the pathophysiology of the human body. For me, I don’t want anyone sticking anything under my skin and keeping a control of me, and my person and my information. I’d rather have it recorded somewhere but not have it taken or have the ability to be taken from inside my own body. What do you think Brian?
Brian: Can I just go back Drew to something you were saying a minute ago when you were talking about people’s health records within your practice? I’m assuming it’s the same with many, many other practices and you were saying that you’re happy for people to look at them, you’re not happy for them to take them away, or photograph them or be left alone with them because you need to protect all the other people within the practice. And it came across to me as somebody who doesn’t have this situation, as you’re protecting everybody in the practice which is wonderful but you’re not protecting the client. Like everybody can see this, everybody has access to it, but the clients, “No sorry, I’m not leaving you alone in a room with this.”
Dr. Drew: Yes. But it’s generally not in my practice, it is generally not the client. But there’s certain things Brian if I can explain. People don’t like to be categorized or labeled and of course, I could be having a serious conversation with the family member in specifically about some behaviors of concern, let’s say that the loved one is vigorously masturbating in the dining room in front of women at the dining table and it’s becoming a problem when we’re wanting to address it. I have been in this scenario where this information, diagnosis, or labeling or categorization of a client, their behavior, their actions has been removed from the records by the loved one who does not want that information in the record. Or accuses an individual of doing something, a professional, a practitioner, a carer, a nurse but they’re following instructions from health professionals in the records and they don’t like the fact this stuff’s being recorded on them. So that’s the litigious area and as I said that’s the high and low culture. I fully support advocacy of clients and I’m happy, I often argue with any of the people I work with. If Mrs. Jones wants to read her record, allow her to read her record and sit with her to protect the document and the integrity of the record. It’s not to stop the person from seeing it, it’s to protect its integrity.
Wayne: Drew, how does taking photos of the record for sharing with your lawyers and other practitioners for medical legal advice challenge the integrity of the records?
Dr. Drew: I know but as I say in certain cases, I would say sure take a photo, 9 out of 10 times I would give him the phone. I’d take a photocopy of it, give it straight back to them say, “Here you go, take the record.” Transparency is the key, however you can’t take it away.
Wayne: It’s the tenth case that is interesting.
Dr. Drew: Yes, that’s right and that’s where most of these legal battles sit Wayne in these tenth cases. And of course for Boomers, older people, I mean I feel for them, do they really want to be sitting in that space? Who wants to be feeding lawyers money over something?
Wayne: Well someone whose mother had a broken leg or who died from maltreatment or was sexually abused for instance because it’s not just unregistered practitioners who commit offenses.
Dr. Drew: I absolutely agree and this is why as I said, I’m a huge advocate for “Let him see the record.” And I’ll even have some hospital managers over the years that go they can’t see the record under our policy, I go “Oh policies, policies, it’s their record. Let them read it.”
Wayne: Now some organizations would argue that it’s actually not their record, it’s an Abe memoir of the clinician and would refuse to release it and if you Google that, you’ll find cases where it has been refused by government agencies. Not a regular thing but on occasion and the only thing they’ll release is the discharge summary.
Dr. Drew: And as I said Wayne, this is a great area of debate conversation, train of thought, get your thinking, get your emotional intelligence going, there I said it. Amanda please pop in with ‘lube, lube, lube’ at anytime. But I do ask the question, what do you guys think that if already we’re arguing and debating health records electronically, they’re already producing the instrument that’s going to be placed under our skin to retrieve this data through a microchip.
Bron: As long as we’ve got an opt-in or opt-out, I think choice is a good thing. I think the whole thing of having mandatory health records is a good thing but I’m not sure about that next level. Maybe in 30 years time? Well, hopefully I still be around. My thinking will have changed when I’ll go, “Oh look everybody knows everything about me. Yes stick a chip under my skin.” At this point in time, I don’t want to go quite that far and if I’ve got the choice, I’m gonna say no.
Brian: This could be one area where Baby Boomers have an advantage because I’m assuming if they’re gonna start putting chips under people’s skins, they’re going to start with the younger people in the community because they’re gonna think the old ones are going to fall off the end before we get everybody done. So let’s start with the younger ones and build up. So maybe a lot of the older people don’t need to bother about this, I don’t know.
Dr. Drew: Perhaps.
Amanda: I’m a little bit different you guys because I’m totally all for it. Unlike if you’re gonna have a little computer chip like in my wrist or something, if I’m found in a car accident unconscious, they can’t sit there and say, “So Amanda, what’s your medical history like?” They’ll be able to take their little wand, put it on my wrist and see everything that they need to know.
Dr. Drew: So Amanda, can we have your eyes and your liver?
Amanda: Absolutely, I’m donating everything to science. They can have everything they want. But that’s the whole thing is that you never know what kind of situation you’re gonna be in and you might not be in the position to be able to tell them your history, or your medical history, or background, or your allergies or things like that. And then instantly someone can like rub a wand over your wrist and be like, “Oh we know, this is the problem” or whatever it might be.
Glenn: Are we allowed to request certain parts of people’s bodies?
Dr. Drew: Where do you want this chip put Wayne?
Wayne: Well the soft edge of this Drew is already happening. I interviewed a firm the other day that’s released a medication. It’s a medication carrier, so you add the medication that you want to monitor to their capsules basically. And the tablet when it’s swallowed, communicates with a skin patch that you wear on your skin and that communicates with an app on your phone and it’s used for medical compliance with, “Did you really take your medication particularly?” And also for where the medication is being released along the gastrointestinal tract. So the thin edge of this is already here. We’ve got cameras that we swallow that take photos although we do have to recover them manually from the other end.
Dr. Drew: The camera tube, I often say, I had a gastroscopy, recently endoscopy both ends and I said to the doctor, “Please make sure you put the one in my mouth before you put the one in my bum and not vice versa.”
Wayne: Yes well I guess someone will look into that.
Bron: I’m intrigued with what body parts Glenn wants.
Dr. Drew: Yes.
Glenn: I’ve got a list.
Dr. Drew: Amanda might be able to offer some “Lube, Lube, Lube,” for you Wayne. We’re getting closer to the end guys but I do want to have this conversation. I do want to give all of you a space to comment on this because this is an issue that over a medical health record that I do want to discuss today. The most important record for me as a person who works around older people particularly people in transition, people without cognition and people who are frailing with chronic comorbidity and entering third and end stage of life. Perhaps, the most important healthcare record, or record or document that I want to know about is the advanced healthcare directive. I am shocked at how many people do not have one, don’t understand what one is and of course, when the critical decision-making time comes, the information on that record is the stuff that I as a nurse, as a leading clinician, as a person who will help govern and care, plan, and make things happen and advocate for my patient, that document is crucial because it represents the person.
Bron: Yep. And no I haven’t done it yet and it was actually on my to-do list for today because my mum’s just had one done. I’m going to do it Drew.
Dr. Drew: Good girl. Amanda, do you have one?
Amanda: I do have one and I’ve had one since I was 16 years old. So I started traveling international at 16 and my mother and father put in place a will and advanced care directive from that point forward and I’ve updated it ever since. And I think that’s the other thing, you need to go back and update it, you can’t just write it and like put it away in a drawer and hope that someday, somebody will find it. So it’s knowing what it is, going back and updating it and letting other people know that you have one is really important.
Dr. Drew: In our clinical review process, we always review the document. If we have one, if we don’t, we then we raise one but we review it. People say to me, “Why are we reviewing that document? It’s already been written.” I go, “Because the person may have changed their mind.”
Glenn: Yes, I like the idea of the update. I think just a reminder sometimes years go by before you think “I only did that yesterday” that’s like, “No, no, that was three years ago or five years ago.” Like all things in life, revisit and refresh.
Wayne: I prefer to live in complete denial Drew.
Dr. Drew: Do you have one Glenn?
Glenn: Yes, I do but I need to return and revisit it. Lindy and I are usually pretty good at doing that kind of thing. And apart from anything else, it just helps you clarify. Every time you do review, you clarify what’s important in life and you clarify some important reminders that some folk wish to be in denial but others, we can embrace them and then celebrate them and go or listen whilst I’m still got some health work. For me, let’s make the best of this.
Dr. Drew: That’s right. You’ve got to check yourself before you wreck yourself. Wayne?
Wayne: Now I’m willing to bet and I have no evidence to win the bet. But I think that we would find more people without them than with them. I think I’m with the majority so I don’t feel special. I know all people are special and you’re all well behaved or complete liars, whatever the case may be.
Glenn: Enjoy that Wayne. It’s not often you’re with the majority mate. You’re usually the outlier, the comparing.
Wayne: This is true. But yes, I think the vast majority of people don’t have them and we haven’t after maybe 10 or 15 years now than being promoted by the medical profession. We haven’t had this massive uptake. So perhaps, we need to do more than occasionally talk about them, perhaps we need something maybe a government enforced opt-in to go with our medical records Drew.
Brian: Yes, rather than the opt-out.
Dr. Drew: Brian, do you have one?
Brian: No. I don’t and I know we’ve touched on this subject before. At that time, I felt quite guilty that I did it. I’ve now gotten over that guilt but I should do one, I always thought and so we had the early conversations. I always thought everybody in my family knows exactly how I feel – my wife, my children, friends, and neighbors, whatever, all know exactly how I feel. But I think you’re right. I think probably it’s important to have one because in the heat of the moment or in the despair of the moment, whatever the case may be, maybe they won’t be thinking straight and they’ll say, “No, no, plug me in.”
Dr. Drew: The thing is I agree with you Brian is the answer I get from a lot of my clients when I sit with them and have this confrontational conversation because they have to be expertly led, they are confrontational, we do these issue raises a lot of emotion amongst family members. But at the end of the day, is I do it succinctly out of respect and love for my patient. And I say that as a nurse and a person who is spiritually connected with the act of loving another human being because I can assure you the amount of times I’ve seen it, been associated with it – there is nothing, nothing worse disrupts your energy levels more when you recover a patient who in their own mind and will are so angry and disrupted and horrible because “Why didn’t you let me die? Or “Why did you resuscitate me?” And “Why have you persecuted me now to have this massive stroke in a wheelchair, in a nursing home or blah, blah.” And when you sit with family, you have to deal with this post event. It breaks families, it breaks human connection, it disturbs people greatly because they thought they were doing the right thing. They thought mum, or dad, older brother or sister would have wanted to stay alive and live, not understanding the consequences of what comes out the end and the work involved in recovery and rehabilitation if that is all possible. And it’s a massive event and an impact on a human being’s life. And at the other stage of that is to when a person is older, and frailing and getting closer to the end of their life, it is terrible to see what happens to them without this testament or point of advocacy of an advanced healthcare directive when we then start to transition them through the revolving door scenario of calling an ambulance, having them resuscitated, bringing them back to care, calling an ambulance, and having them resuscitated, and save their life and bringing them back to care. And all of a sudden, they are no longer in a position to give you the order and so this revolving circle continues, and continues and continues and the suffering on the individual is almost unbearable to nurses like myself.
Glenn: Indeed. If we’re looking at the health records, it’s not always about staying alive as much as the Bee Gees sing their song, sometimes there is a call you want to make where it’s goes beyond staying alive. I know for both Mum and Dad that was their call, “Take me out of here.”
Dr. Drew: I’ll be taking the stairway to heaven Glenn.
Glenn: That’s a good one. And I thought Brian’s thrown in guilty by the Bee Gees and I’m gonna throw in Billy Joel’s “Honesty is such a lonely word.” We’ve got to be honest with ourselves at these times now with our own health records.
Bron: Well I think that’s the best one with ourselves.
Wayne: I’d like to take this moment to change gears.
Glenn: You’re changing gear. Now that we’re on visual radio that we can see you’re getting changed, this is good.
Wayne: Maybe I can think of a better analogy there. Last week, we did promise to answer some questions from listeners and I’d like to just try and honor that promise with one if we can change topics for a moment and switch our mental cognitive processes to the issue of when is the right time to get an enduring power of attorney? Now our question is from Michael in Brisbane in Bowen Hills, if we can turn our minds to when is the right time to approach your spouse, to approach someone that you’re care for about an enduring power of attorney?
Amanda: That would be from 18 years old onwards?
Amanda: Now. Yesterday was a great time if you don’t have one.
Wayne: Now the cynic in me says, supposing that at age 22, give my wife partner and lover forever an enduring power of attorney and then we get divorced, how can the enduring power of attorney be used against me?
Dr. Drew: You undo it.
Amanda: You undo it and you provide it to somebody else. You give the rights and responsibilities to your parent, or a loved one, or a cousin or a best friend, so you undo it.
Dr. Drew: But I’d like to know too in context to the gentlemen in Brisbane that’s asked the question. His name?
Dr. Drew: Michael. What I will do is I’m hoping, I’m hypothesizing that his question sits around probably an elderly loved one or someone he’s probably thinking about “I should take control as a family member because I’m the oldest son,” perhaps or something like that.
Wayne: It’s a family member scenario, yep.
Dr. Drew: Because I get asked this question a lot through Facebook in Dr. Drew, A Big Man Talking. Ironically, it’s usually sits around mum has just got a diagnosis of dementia or dad’s just being given a diagnosis of dementia, when is the right time to execute enduring power of attorney? So this is a challenging question. Mum and dad are being very fiercely independent their whole life, they’ve just been given a diagnosis of something – at what point do we now challenge and address this issue? Because what they’re basically saying is “Mum, dad you’re gonna lose your mind and you won’t be able to make your own decisions. Can we have this discussion?” And so these are quite emotional issues but rather than me drag it out, for all the listeners, I will put up a little video that I’ve already got prepared, so it’ll probably go up the next 24 hours for Wayne to put on the website and it answers these questions quite succinctly and they’re not hard decisions. I’m with Amanda, do it yesterday. If you haven’t done it, start having the conversation today.
Wayne: So there you are Michael, we’ve got one that Drew cooked earlier for you and we’ll have it on the show notes of this episode. For the rest of our conversation, we have some other questions but we might leave them go because we’re running short on time yet again. Can I ask for any final comments here before we wrap up for the week?
Bron: I think probably the thing that I say most often is take responsibility for yourself. This is what this is about and decide what it is that you want and then do it.
Wayne: Thank you Bron.
Glenn: And as part of that responsibility, I’d say let’s get physical and go walking on sunshine.
Wayne: I was just wondering where we could put that Fitbit Glenn but never mind, I’ll move on. Brian?
Brian: I think I’ll just go out of the national anthem because I can’t think of any other songs. But I agree, I am actually going to do it and I will have the conversation with my nearest and dearest and I will let them know that I’m doing it and I will send them copies of it and do all those things that the government is threatening to do for me.
Glenn: And if you’re not with us next time Brian, we will send somebody around to check out the family.
Dr. Drew: That’s right. See if there’s any fresh turf in the backyard.
Amanda: I would say there’s no day like today. So if you haven’t already done it, go ahead and do it, take some action because action is much better than words.
Wayne: And Drew, do you have a last word for us?
Dr. Drew: I do. On the subject of e-health records or anything really, growing up is optional and growing old is mandatory. But as you age and get wiser, don’t take the wrong option.
Wayne: I’m not sure which is the right option that’s the problem, but never mind.
Brian: Yes, that’s very deep.
Wayne: I’ll stay with it. Dear listeners, thank you for being with us. Panelists all, thank you for being with us. Thank you Glenn Capelli, Brian Hinselwood, Bron Williams and Amanda Lambros. My co-host Drew Dwyer, it’s been a pleasure hosting with you once again. You’ve been listening to Booms Day Prepping, our regular look at what life’s like for Baby Boomers and getting ready for the next stage of life. If you do have questions like Michael from Bowen Hills, please feel free to send one in by any of our social media channels, we’d love to hear from you. If you don’t have questions, just push the like button because we really do suffer from ego problems and we need you to embrace us, and support us and love us. And if you’re a marketing representative of Fitbit, we look forward to receiving your check because I think we’ve mentioned your product today more than any other ever in the history of the program.
Dr. Drew: Absolutely, I so agree with that.
Wayne: If you got a question like Michael, we’d love to hear from you. Please feel free to ask your questions in any of the social media channels or on our website. And while you’re on the social media channels, do click the Like, Share and We Love You button because we appreciate your feedback. My name is Wayne Bucklar, this Booms Day Prepping.