Tuesday, January 29, 2013

Day 227 - OK labs

Dr. Hill just called to let me know my labs, while still not perfect, are moving in the correct direction. My platelets were 30 too low last check, now they are 15 too low so--progress. We're going to recheck in 10 to 14 days and hopefully they'll be all back to normal.
I had an interesting experience at the POLST training session yesterday that I wanted to get your opinions on. We were role playing and a pretend patient asked me how likely it was that I would not be able to get his symptoms under control at the nursing home he lived at, how likely it would be that he would have to transfer to a hospital for symptom control. I told him that I had only had one patient in the ten years that I worked there who had had that problem. Afterwards, he told me that that method of expressing a very low probability (which is what I was trying to do) was actually anxiety provoking and that I should find a different way. I thought that was interesting because I have used that method a lot and have not noticed anyone seeming to be made more anxious by it. What do you think?
We also talked a little bit about the studies that have shown people have a harder time understanding 5% than "1 in 20." People who study these things say that your average person gets what 1 patient of every 20 means better than they understand 5% and that it is not obvious to many (most?) that they are the same. For this reason, people recommend that you give numbers as proportions rather than percents. For events that are much less than 1%, it seems that saying "one tenth of one percent" or even "one in one thousand" are hard to wrap your head around. My "happened once in ten years" was an attempt to say essentially, "it happens, but is pretty rare." How else could I say that?
Otherwise, today was a fairly normal day. I was not as tired from eight hours of education yesterday as I feared I might be, but I felt not quite 100% today. Sorry, I felt not quite 1 in 1. I felt more like 4 people out of 5 people. (as long as all five were silly)
For me, for tomorrow, I will hope for back to normal energy. For you, I will hope for the energy to do what you want to.


  1. Well, I have been thinking about this for a couple of days! You were proberbly looking for a more professional response and maybe got one through e-mail. Patiens most often do not like #'s. I hear that. Or i feel it" in conversations. 50 50 is the worst. being honest and saying, we are doing everything we can to keep you out of the hospital is enough. Or we dont have the resorses we need here and a hospital visit
    maybe necessary to help you get better. Or , you will have a better chance of getting better with more
    aggresive treatment available in the hospital. In the end of life. We want you to be were you will be most comfortable.
    Ok now I am rambling.
    Is this what youvwere looking for.

  2. Yes, that is the kind of thing I was looking for and specific feedback about the "it happened once in ten years" statement. Thank you.

  3. I'm sorry, again I had to read 1 in 20 and understand 5%. Think I got it. I think that social history 1 in 20 people smoke populates to 5% of 100 people smoke ( just a refrence). I think if you said 1 in 20 people smoke sound like more than 5% of the population smoke. " I like social history, I don't thinknit should be spacific to what the providers wanr, I think there is a lot of useful information that can be useful to reserches in the next decades, with out vilating a persons privacey.

  4. I like social history too. I agree that getting what you can and documenting it is key because somewhere down the line, stuff may be important that is not important today. Social history is hard because it doesn't fit as well into the click click paradigm that we are all moving towards. It is harder to make social history fit into five distinct categories and require a person to check one.
    I think you are right that the percentage (5%) and proportion (1 in 20) seem different.