Including Families and Caregivers

"What would you like your family to know?"

Family and informal caregivers play an important role in the lives of their loved ones. They also play an increasingly important role in how the health care system functions. By communicating effectively with all the individuals involved in your patient's care, you can help him or her while making efficient use of time and resources. Informal caregivers may be important "informants." They can also help to reinforce the importance of information you give or the treatment you prescribe. When a companion is present, be aware of communication issues that arise in three-party interactions. Too often, the conversation may be directed at the companion and not at the patient; in some cases, the encounter can become a "two against one" match, which no one really wins. Whenever possible, try to sit so that you form a triangle and can address both the patient and companion face-to-face.

To protect and honor patient privacy, be sure to check with the patient on how he or she sees the companion's role. In many cases, the caregiver or companion can be a facilitator, helping the patient express concerns and reinforcing what you say. But it is best not to assume that a companion should be included in the medical encounter. First, check with the patient. Conducting the physical exam alone protects the patient's privacy and allows you to raise sensitive issues. The best time to conduct a "mini-mental" exam is during a private exam, so that a family member cannot answer questions or cover for the patient's cognitive lapses.

Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairments. If a family member has been named the health care agent or proxy, under some circumstances, he or she has the legal authority to make care decisions. However, without this authority, the patient must make his or her own choices. Try to set clear boundaries with family members, and encourage others to respect them.
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Deconstructing the Digital Era

Senator Ted Stevens thinks the internet is a "series of tubes." George W. Bush believes there are internets galore out there. And John McCain...well, the Senator has admitted that he doesn't even know how to use a computer. Politics in the digital era is tricky, not so much because of the wealth of information on the web, but because of the millions of ordinary Americans using that information on a daily basis. Armed with new media tools, muckrackers today number in the millions. No longer is a candidate able to present a poll-tested package to the press and have that persona spoon-fed to the American people. No, today's voters have available to them a universe of information consisting of detailed voting records, primary sources, debunking sites, blogs, and more.
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Nursing Homes

Skilled nursing facilities (SNFs) and nursing facilities (NFs) are required to be in compliance with the requirements in 42 CFR Part 483, Subpart B, to receive payment under the Medicare or Medicaid programs.
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Fiber

An apple a day--that is, a whole apple with the skin--will give you approximately 3.6 grams of fiber. That's a good start, but you still need a lot more fruits, vegetables, and whole grains to meet the daily level of 20 to 30 grams of fiber recommended by the National Cancer Institute. Eating foods with plenty of complex carbohydrates and fiber (vegetables, fruits, and grain products) is part of a healthy diet for several reasons.
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Preparing Ground Beef for Safe Consumption

Wash hands with warm, soapy water for at least 20 seconds before and after handling raw meat and poultry. Wash cutting boards, dishes and utensils with hot, soapy water. Immediately clean spills. Keep raw meat, fish and poultry away from other food that will not be cooked. Use separate cutting boards for raw meat, poultry and egg products and cooked foods.
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