Frequently Asked Hospital Questions – What’s an “Advance Directive” and Do I Need One?

An Advance Directive is a written statement that you complete in advance of serious illness about how you want medical decisions to be made. The two most common types of Advance Directive are a “Living Will” and a “Durable Power of Attorney for Health Care.” Here’s a quick breakdown of the two –

• Living Will (also referred to as “Declaration”) – This is a statement specifying the kind of care you want (or don’t want!) in the event that you’re unable to make your own medical decisions.
• Durable Power of Attorney for Health Care – This is a signed, dated, and witnessed paper that allows another person, such as your spouse, son, daughter, or close friend to make medical decisions for you if you’re unable to do so.

Or, you can opt to have both a Living Will and a Durable Power of Attorney for Health Care through something called a “Combined Directive.”

Do I Need an Advance Directive?
Legally speaking, you don’t HAVE to have an Advance Directive.  That being said – if you want to influence the direction of your care, then it’s a good idea to have one. Anyone age 18 or older can create their own. Keep in mind that individuals should only create an Advance Directive if they are competent and capable – for example, don’t wait until you’re already showing signs of dementia to create your Living Will or any other type of Advance Directive. Additionally, because unexpected situations can happen at any age, all adults should have an advance directive. Moral of the story – When it comes to creating an Advance Directive – the sooner you do it, the better!

What Happens to Patients at the End of their Lives if they Don’t Have an Advance Directive?
In this case, the hospital would look for the next of kin to make decisions. Unfortunately, this individual may not be the best person to represent your wishes. To help prevent this from happening – the federal law requires that, when a patient is admitted to the hospital in a nonemergency circumstance, the patient MUST be asked whether they have an Advance Directive, where it is located, and the name of their health care surrogate. Many hospitals also offer a simple directive for patients to complete when they’re admitted.

What are the Common Types of Instructions to Include?
Do you want to be an organ donor? And how do you feel about receiving CPR? When it comes to personal decisions like this, it’s all a matter of preference. And if you want to have a say in critical decisions, then you’ll need to create an Advance Directive. To learn more about organ donations, Do Not Resuscitate Orders, and other care related decisions that you may want to provide direction on, go to http://www.mayoclinic.com/health/living-wills/HA00014.

For more information about Advance Directives, go to www.carsontahoe.com/Advance-Directives.

Are Robot-Assisted Surgeries Safe & Worth the Extra Cost?

When considering robotic surgery always remember to ask the right questions and be your own advocate. Keep in mind that all the advertisements, commercials, and marketing materials promoting robot-assisted surgeries are just one side of the story. Now that robot-assisted surgeries have been performed for several years, researchers have had the opportunity to collect a large amount of data uncovering some very interesting findings on the safety and cost of these robotic surgeries. Watch NBC’s Rock Center report below to learn more about the debate.

One thing is consistent in the studies – robot surgeries are much more expensive than the traditional procedures, and, with a few exceptions, do not improve surgery outcomes or shorten recovery times when compared to alternative procedures. On the other hand, the robots have been a helpful recruiting tool for hospitals, with many surgeons preferring to use them over other methods. Are robot-assisted surgeries better? There is no cut and dry answer…and so the debate continues. Let’s take a look at the facts and then you can decide for yourself.

How do Robots Work?
The patient lies on the operating table while the doctor sits a few feet away at a console, where he or she can manipulate the robotic arms while watching the procedure through a 3-D viewfinder. Surgeons control the robot’s camera and four arms using tiny joysticks and foot pedals to perform the surgery.

What are the Advantages of Robot-Assisted Surgery? –
Some surgeons report that they enjoy and prefer using robots; they also feel that the robots are easier to use because they don’t need a (human) assistant to operate the camera. Many people in the general public have a general positive perception of the robots. The majority of robot-assisted surgeries have performed with relatively safe outcomes.

What are the Disadvantages of Robot-Assisted Surgery? –
Robot-assisted surgeries are no bargain, tacking on about $2,200 more per surgery than other methods, which is most often passed on to the patient. Speaking of costs – the purchase price can be up to $2 million per robot, and ongoing maintenance fees cost over $100,000 annually.

Studies show that surgical outcomes using the robots were not any better, and recovery times were not shorter. In a statement put out in March by Dr. James Breeden, MD, FACOG, a local physician on staff at Carson Tahoe Health and president of the American College of Obstetricians and Gynecology, “aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice. Our patients deserve and need factual information about all of their treatment options, including costs, so that they can make truly informed health care decisions.”

And then there’s the steep learning curve…the robot manufacturers do not provide training – the hospitals must figure it out on their own. Not only that, but surgeons need to perform the surgery many times to become proficient at it.

Lastly, according to the FDA, there have been 200 reports since 2007 of burns, cuts and infections – including 89 deaths — after robotic surgery.

What’s a Patient To Do?
The big takeaway here is to remember to always ask the right questions and be your own advocate. According to Dr. James Breeden, “Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated.”

We are committed to using advanced technology that results in improved patient outcomes and shorter recovery times. Based on these standards, the robots do not outperform skilled, ‘human’ surgeons at this time.

To learn more about surgical services, go to http://carsontahoe.com/surgery

Sources:
1. NBC – http://rockcenter.nbcnews.com/_news/2013/06/14/18958967-robotic-surgery-is-high-tech-tour-de-force-but-is-it-safe?lite”
2. American College of Obstetricians and Gynecology - http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Statement_on_Robotic_Surgery
3. NPR – http://www.npr.org/2012/03/19/148939374/medical-innovations-can-come-at-a-cost?sc=emaf
4. USA Today – http://m.usatoday.com/article/news/1928689
5. Huffington Post – http://www.huffingtonpost.com/huff-wires/20130314/us-med-robotic-hysterectomies/?utm_hp_ref=green&ir=green
6. Business Week -  http://www.businessweek.com/news/2013-03-14/robot-surgery-isn-t-most-cost-efficient-hysterectomy

Crab Toasts with Creamy Sriracha Sauce Recipe

Some days just call for a yummy, spicy, seafood combination… 

Enjoy this delicious recipe that pairs sweet crab meat and fiery sriracha.  

Serves 4

For the crab toasts:
4 slices good sourdough bread
3 tablespoons creamy Sriracha  (see recipe below)
8 ounces picked lump crabmeat, preferably peekytoe, picked over for bits of shell
Crushed red chile flakes, optional
1 lemon, cut into wedges

For the creamy sriracha sauce  aioli (makes 1 cup):
1 large egg yolk
1 tablespoon Dijon mustard
½ teaspoon kosher salt
¾ cup grapeseed or other neutral oil
2 teaspoons fresh lemon juice
2 teaspoons sriracha

Directions

To make the crab toasts:
Toast the bread until golden brown. Cut each slice into 2-inch pieces.

Gently fold the mayonnaise into the crabmeat until well mixed. Spoon the crab mixture into a serving bowl and set inside a larger serving bowl filled with ice to keep cold if desired. Garnish with chile flakes if desired. Serve with the lemon wedges and toasts.

To make the creamy sriracha sauce:
Whisk together the yolk, mustard, and salt until well blended. Continue whisking while adding the oil in a slow, steady stream to emulsify the mixture. Whisk in the lemon juice and sriracha until well blended. The mayonnaise can be refrigerated for up to 2 days.

Source: www.toastcarsontahoe.com