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February 28, 2007

You Are In Charge

Patricia A. Kelly

Throughout the week I will be out the door early every day and home late. I'll make phone calls on the way to work, exercise (maybe), run errands at lunch, buy food, go to the dry cleaner, cook and clean.

When it's winter, I'll shovel snow. In summer, I'll work in the yard. I'll feed the cat, change the litter, brush her at least twice a year - you get the picture. You with children, parents, spouses, volunteer work, etc., to take care of, you'll be doing even more.

We're all so busy. We don't have time for everything. So we hire people to take care of us. We hire doctors, lawyers, mechanics, and legislators. Some of them are wonderful. Some of them are not. We, the too-busy and the too-tired, do very little to check them out.

What they do, though, is up to us. And while we're not watching, they're keeping busy.

Our legislators are making laws. A column in the Frederick News Post by Jonah Goldberg, dated January 13, 2007, listed some of the laws that the New York City Council enacted, or attempted to enact, just in 2006.

Attempts were made to ban pit bulls, trans-fats, aluminum baseball bats, the purchase of tobacco by 18-to 20-year-olds, pedicabs in parks, new fast food restaurants in poor neighborhoods (!).

If they were part-time like our local officials, I wonder how they found the time. I can't imagine that they had any time at all for meetings and golf outings with lobbyists, another popular activity among legislators.

Our doctors are, hopefully, working conscientiously, reading up on the latest medical advances, collaborating with colleagues, and attending seminars as needed. Many are meeting with - and receiving gifts from - drug company representatives.

These drug reps, known by less attractive drug company employees as Barbies and Kens, offer wonderful food, support for seminars, gifts, samples, etc. They ask for time to pitch their new drugs, providing test results to demonstrate that these drugs, expensive and not available in generic form yet, are necessary advances. Sometimes this is good information, and sometimes not. Good doctors do not change their prescribing habits in response to these encounters, without corroboration.

Our mechanics are often making the difference for us in whether we live or die, too. It's open knowledge that there are bad ones, so we often check their references before hiring them.

Lawyers run the gamut, from the most amazing and wonderful lifesavers, to people you would not trust to take out your trash because you know they would leave something stinky in the can. If I had another few pages of space available here, I could tell some stories!

The bottom line is that we are our best defense and we must defend ourselves - against everything from the unconscionable waste of our tax dollars to the thousands of deadly medical errors in this country every year to the endless stories about Anna Nicole. No matter how harried we are, we can remain alert, ask questions, and say no.

We are much more willing to do this when dealing with a mechanic or an electrician than we are with a "professional," but they are all people, from the local surgeon to the attorney general, putting their pants on one leg at a time, just like you and I. They are the professionals. The onus is on them.

Before you hire a doctor, get references. If an operation is recommended, get a second opinion. If it's a big operation, make sure it's done a lot by the surgeon, the team and the hospital. Ask for outcome and complication statistics. Ask for a clear definition of "benefit from." Make sure you don't accept a new prescription without informing your doctor about what you're already taking.

If it's your legislator, you'll hear how wonderful he is from him, at every election time. Demand quality behavior between elections. Find out his voting record. Find out where he gets his money, and who is paying for his plane trips. Demand an open accounting. Make him be the one spending the time to provide you with this information. Tell your news media representatives - in clear and understandable language - that this is what you want to read about, not more about poor Brittney.

Remember that proposed O.J. Simpson book and TV special? It was an offensive idea, repugnant to our society. People expressed that opinion, loudly. It was cancelled. Objecting to it did not take much time.

I keep thinking about a group of nurses in a hospital where I once worked. The medical-surgical nurses, when understaffed or overly busy, began refusing to admit more patients. It started on one unit with a very assertive charge nurse. She was asked to go home during her shift so the supervisor could take over, and the admissions could proceed. She said, "No. I'm not going home, and we're not taking more patients."

She ended up resigning, of course, but for months afterward admission policies changed and the nurses controlled how many patients they cared for. If you read the statistics relating patient safety to the number of patients per nurse, you'll be impressed. I know I'll never forget this demonstration of nursing power.

You don't have to be educated, or have credentials, or even much time, to influence what is happening around you, even in a fast-paced world where your doctor doesn't know you well enough to know which leg to cut off.

Even in a world where the person you know best is a pathetic movie star who lives thousands of miles away, your responsibility is only to do what Oprah says and, "Live your best life." Don't be embarrassed or feel inferior or powerless. Stay alert, attempt to live according to your own values, and demand the best from those you hire - from your doctor to the local newscaster.

Go for it.


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