Beware the Grieving Warrior

Beware the Grieving Warrior: A Child's Preventable Death. A Struggle for Truth, Healing, and Change
Larry Hicock with John Lewis

"This book is a riveting read not only because of its heart-wrenching outcome and local characters, but because of its potent topicality: According to data collected from Britain, Australia and the U.S., an estimated 10,000 Canadians die in hospitals annually as a result of medical error, another 10,000 from incidents like hospital infections and unexpected drug complications. It's something we always hear, but due to a naive trust in our medical system, rarely put into action: You are your best advocate."
- Hamilton Magazine

In early 2003, Ontario's deputy chief coroner ordered an inquest into the tragic deaths of two children due to post-operative complications in a Hamilton hospital. The cases may never have been reported were it not for John Lewis, a registered nurse, and father of 11-year-old Claire -- one of the two children.

Beware the Grieving Warrior describes John's fight, in the midst of immeasurable grief and sorrow, against hospital staff and administration who failed to acknowledge their neglect. By turns shocking and heartrending, infuriating and inspiring, this book offers a chilling first-hand account of the obstacles and resistance Lewis encountered as he wound through a hellish maze of bureaucracy, until he won his day in court. The story is intensely intimate and brutally honest. It is about the suffering that inevitably results -- for patients, their families, and for the health care professionals involved -- when the truth is withheld.

At Amazon
http://www.amazon.com/Beware-Grieving-Warrior-Preventable-Struggle/dp/1550226738
At ECW Press
http://www.amazon.com/Beware-Grieving-Warrior-Preventable-Struggle/dp/1550226738
As eBook
http://www.diesel-ebooks.com/cgi-bin/item/1554906733/Beware-the-Grieving-Warrior-A-Child's-Preventable-Death-A-Father's-Fight-for-Justice-eBook.html

CMAJ - Apology marks new era in response to medical error, hospital says
http://www.cmaj.ca/cgi/content/full/168/6/757

Grieving father John Lewis says there are no "real winners" in this case
http://www.cmaj.ca/cgi/eletters/168/6/757#273

Patient Beware
http://www.readersdigest.ca/mag/2004/06/patient.html

CMAJ: Medical errors, apologies and apology laws
http://www.cmaj.ca/cgi/content/full/180/1/11

Articles by J.E. Lewis at NIH
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term=Lewis%20JE%5Bau%5D&dispmax=50

Doctors find confession is good for the soul
http://www.rd.com/living-healthy/doctors-confess-their-fatal-mistakes/article185422.html

The foundation established in memory of Claire Lewis is called Revolution Hope.

Radiographics and the Thyroid

http://radiographics.rsna.org/content/19/5/1161.full
Navigating the thoracic inlet with radiography.
Discusses and presents images of thyroid conditions such as Cancer, Pyramidal Structures, Hemiagenesis and more.

Thyroid Health: Causes of Damage, Symptoms and Natural Solutions

On Hypothyroidism

Thyroid Imbalance: Causes, Symptoms, and Natural Solutions

On Hyperthyroidism and Hashimoto's Disease
Article by Dr. Zoltan P. Rona, MD, M.S.c.

Six Sigma and Medical Care

Does your hospital utilize Six Sigma in its planning and methodology?
Six Sigma Catapults Hospitals to Next Level of Quality
If not, the consequences can be very costly to you...and to the hospital.

"Lawsuit could set precedent about end-of-life decisions

Robert Cribb
Toronto Star
Staff Reporter
September 04, 2010

As her father lay struggling for breath in a Toronto hospital bed, Joy Wawrzyniak pleaded with doctors to intervene and save his life.

Medical staff instead stood back and allowed the World War II veteran to die, against his wishes and to the shock of his daughter, Wawrzyniak claims in a stunning $1 million lawsuit filed this week against Sunnybrook Health Sciences Centre and two doctors responsible for her father’s care.

While Wawrzyniak and her father, Douglas (Dude) DeGuerre, had repeatedly requested he receive life-saving treatment in case of a medical emergency, doctors unilaterally overruled those wishes without consent or consultation, the lawsuit claims...."
Lawsuit could set precedent about end-of-life decisions

Thyroid T3 Recovery from Fibromyalgia

What if... your doctor prescribed years of pain killers and antidepressants for your Fibromyalgia... when what you needed was thyroid supplementation?


"Recovery from "Fibromyalgia" with T3
Therapy after T4 and Desiccated Thyroid Failed

Fifteen years ago, I published a case study in which a hypothyroid female dramatically recovered from her diagnosis of fibromyalgia by swithching to T3 after she had failed to benefit from both T4 and desiccated thyroid.
Fibromyalgia researchers who work with their heads buried in the sand of failure will dismiss the case, as they did all those years ago, because the report isn't about a blinded study. However, as Carlton Fredericks, PhD noted, such reports are controlled. After all, the woman recovered quickly and dramatically with T3 after extensive treatment with two other approaches to thyroid hormone therapy failed. It is a failure of intellect that dismissive fibromyalgia researchers saw (and undoubtedly will still see) the study as "uncontrolled." By the very unfolding of the woman's case, the trial was indeed controlled.

This highly illustrative case of recovery from "fibromyalgia" through thoughtful administered T3 therapy has for many years been unavailable except through my office. The reason is that the journal containing the report was sold in 1996 to Haworth Medical Press, which didn't make the issue containing the report available to subscribers.

Today, however, Thyroid Science makes the case report available for perpetuity through its open-access webpages. For those who are curious about T3 therapy and its proper use, and how so-called "fibromyalgia" can be relieved with hormone treatment, we republish this case report. "

Introduction to the Case Report at THYROID SCIENCE

Do you trust your doctor?

Do you trust your doctor? Increasingly, many (Canadians) do not.
It may be wise to ask questions. Today, university medical education is often funded by Pharma (grants to chairs and departments, for research, dictating what shall be taught) and continued in the doctor's office during visits by drug company reps with high school educations and doctor prescribing info and personality profiles on their Bl*ckberries.

From an article at Maclean's

...horror stories have made Canadians wary, says Mario Canseco of Angus Reid Public Opinion, who oversaw the Maclean’s poll. “Not only do they worry that there will be mistakes, but they assume so,” he says. “Even if you’re happy with your GP, you see what’s happened to those around you. You think it may be your time next.”

For doctors, this is an unaccustomed, and not especially pleasant, spot to be in. For generations, physicians have enjoyed greater public respect and appreciation than practically any professionals—a reflection, perhaps, of their status in many communities as the most educated people in town. That’s changing, however, as post-secondary education becomes the norm and Canadians in general grow less deferential. “There used to be a very paternalistic relationship between doctors and their patients,” says Dr. Rocco Gerace, registrar of the College of Physicians and Surgeons of Ontario. “It worked both ways. Patients would essentially give doctors the decision-making ability, as opposed to considering options and then consenting. It’s changed dramatically, and I think for the better.”

That shift has been accelerated by the Internet, which puts not only diagnostic information but reviews of individual physicians at the fingertips of patients. RateMDs.com, a California-based site that went online in 2004, has doubled its traffic every year since, with Canadians as its most enthusiastic constituency. The site now has user-submitted ratings for over 85 per cent of Canadian doctors, and a surprising 45 per cent of its 1.2 million monthly visits originate in this country. The phenomenon speaks not only to patients’ doubts, but an appetite for frank criticism that Hugh MacLeod, chief executive of the Edmonton-based Canadian Patient Safety Institute, says will only grow. “For those in the system who think things are getting wild now,” he says, “put on your seat belts.”

All this crowd-sourcing raises an obvious question: are medical mistakes becoming more common? Or are they merely being amplified by proliferating media, both social and mainstream? Geoff Norman, a McMaster University psychologist who studies how doctors make errors, believes recent scandals played out in the media have simply caused patients to demand reviews and investigations, the coverage of which has fed impressions that things are going awry. Doctors are more willing to own up to mistakes, he argues, and he points to the publication in 2000 of “To Err Is Human,” a report by the Washington-based Institute of Medicine, as a watershed moment in encouraging practitioners to acknowledge their fallibility. “Now,” he says, “there’s almost like a legislative review process when something goes wrong.”

http://www2.macleans.ca/2010/08/16/do-you-trust-your-doctor/
Print version
http://www2.macleans.ca/2010/08/16/do-you-trust-your-doctor/print/

The link between adrenal fatigue and DNA methylation

Link

The link between adrenal fatigue and DNA methylation
Townsend Letter for Doctors and Patients, May, 2005 by Susan Solomon

Adrenal function is vital to life: without cortisol we die. This fact has been known since the 1930s when it was described by Banting and Best. Glucocorticoids are essential for maintaining carbohydrate, protein and fat metabolism. They also have a permissive effect which allows for glucagon and catecholamines to work. Important glucocorticoid effects include the normal functioning of the nervous system, water metabolism, vascular reactivity, regulation of circulating lymphocytes and the immune system and "resistance to stress." Complete lack of adrenal function is a disease state known as Addison's Disease. Conventional medicine only recognizes two states: you either make cortisol or you don't. Allopathic physicians are unaware of the decline in adrenal function as illness becomes chronic.

The etiology of adrenal fatigue begins with a "stressor," or in functional medicine terms, a "trigger." Triggers fall into several categories: psychosocial stress, environmental toxins (radon, mercury, mold), infectious organisms (fungal, bacterial, parasitic), food allergies (wheat, corn, sugar, milk), and other toxins (alcohol, drugs, prescription medications) to name a few. In addition, stressful events such as surgery or car accidents place a huge (usually unrecognized) load on the adrenal glands. The initial response to each of the above events is to elevate cortisol levels to help cope with the stress. However, over time, the adrenals become weakened and lose their circadian rhythm. This is due in large part to poor nutrition. All stressful events require increased amounts of several nutrients: vitamin C, pantothenic acid, B6 (pyridoxine), B12 (methylcobalamin), and folate. Interestingly, if the adrenal glands are catheterized and a "stressor" is introduced, the first chemical to leave the adrenals is not cortisol as one would suspect, but large amounts of vitamin C. These nutrients are severely lacking in the typical American diet or are not found in high enough amounts. More often than not "orthomolecular" dosing is necessary to correct the deficits.

The initial response to any stress is the hypersecretion of cortisol, but over time (approximately one year) there develops a negative feedback and a genuine "fatigue" causing reduced levels of DHEA-S and cortisol. The end result is an organism with reduced immunity, increased likelihood of autoimmune disease, heart attacks, elevated cholesterol and triglycerides, skin disorders, carbohydrate cravings, protein wasting, fatigue and depression (to name but a few). Physicians normally view these as separate events in a given organ and do not see that the symptoms represent a disease process (inflammation) that may occur in one or more organs simultaneously. Therefore everyone with any chronic disease, not just cardiovascular disease, should be screened using DHEA-S and a homocysteine level. As DHEA-S decreases, the level of homocysteine rises, with a concomitant decrease in most B-vitamins, but especially folate and B12. The currently accepted norms for these parameters are too permissive, reminiscent of glucose control in years past. All of our organs are linked and nothing that happens is random. We are all the result of our genetic interaction with our environment.

With the establishment of "disease" another pivotal biochemical event happens: abnormal methyl metabolism. Multiple reports in the recent literature link abnormal DNA methylation with the onset of cancer in laboratory animals. Undoubtedly this occurs in humans as well.

It is my clinical experience that as soon as a patient's DHEA-S falls to below 160 the ability to make methyl groups nosedives as well. These patients may then present with symptoms of depression (inability to synthesize S-adenosylmethionine), joint pain (inability to make methylsulfonylmethionine), and gastric acid reflux disease (inability to make betaine or trimethylglycine), to name a few. Not only does the ability to make methyl groups decrease, but the ability to convert to a methylated product is also compromised. For example, in chronically ill individuals the use of B12--as either the cyanocobalamin or the hydroxocobalamin form seems to do little to improve fatigue or mental functioning. The ideal compound to replenish B12 is methylcobalamin--the only active form. In each case, oral supplementation with the missing methyl-containing substrate ameliorates the symptoms. In each of the scenarios listed, the severity of the illness correlates with the level of the reduced or deficient DHEA-S and the concomitant elevated homocysteine level. The elevated homocysteine level is not only a marker for inflammation, but it is a marker for deficient B vitamins as well. The stage is now set for abnormal DNA methylation and the induction of cancer.

Efforts to repair adrenal fatigue include nutrients (in their most active form), glandular preparations, DHEA (and in severe cases cortisol itself), and lifestyle modifications with removal of triggers. Even with these measures, expect adrenal recovery to take 3 to 5 years.

Does your physician know that DHEA is an endocrine hormone, essential for life - or does he think it is a health food supplement?

Bibliography at link

A framework for assessing the performance of health systems

Theme Papers
A framework for assessing the performance of health systems
Christopher J.L. Murray1 & Julio Frenk2
Health systems vary widely in performance, and countries with similar levels of income, education and health
expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the
understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities.
Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and
autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt
attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge).
By investigating these four functions and how they combine, it is possible not only to understand the proximate
determinants of health system performance, but also to contemplate major policy challenges.
Keywords: outcome and process assessment, health care; health care rationing; health services accessibility; social
justice; health systems plans; financing, health

PDF

Beyond Mediocrity: What Canadians Should Expect From Their Healthcare System

... And Why They're Not Getting It
Thought provoking and honest.

Public Presentation by Steven Lewis, U of Calgary/SFU
Dalhousie University School of Health Administration
Halifax, N.S.
Audio/slide presentation
Link

'What Would You Think If...
Your dry cleaner made you wait 3 weeks for your clothes
7% of the meals you ate in restaurants gave you food poisoning"

Part of a series - http://schoolofhealthadministration.dal.ca/Excellence%20in%20Health%20Series/

"Excellence in Health Series
Tomorrow’s Thinking ~ Today’s Care

In 2008 the School of Health Administration established a public-education program entitled, Excellence in Health Series. The Excellence in Health Series is designed to provide an open forum, equally accessible to the public and professional community. The lectures provide a ‘large-canvas’, upon which cutting-edge topics are discussed, from healthcare planning and management, healthcare funding and delivery, healthcare law and legislation, to healthcare policy. All members of the public are welcomed, as are healthcare professionals, from healthcare practitioner, policy analyst, lawyer, to healthcare administrator. To maximally engage the public, the series is held in the evenings, off campus, at a local Hotel, and no admission fee is charged.

The Excellence in Health Series will feature national and internationally lecturers, each respected for their leadership on the topic of discussion. To ensure maximum learning opportunity to the public and professional communities throughout the region, nationally and internationally, the Excellence in Health Series is digitally recorded and made available through the School of Health Administration website.

Beyond Mediocrity: What Canadians Should Expect from their Healthcare System and Why they're not Getting it.
By: Steven Lewis

Medicare and the Law: Playing with a Full(er) Deck
By: William Lahey

How to Reduce Your Risk of Experiencing a Medication Error
By: Dr. Neil MacKinnon

A Weight On Our Minds: Obesity in Nova Scotia
By: Dr. Sara Kirk

Population Aging and Health Care
By: Dr. Kenneth Rockwood

Coronation Street star speaks out on her thyroid condition

We are grateful when awareness of thyroid health can be raised. Britain's CORONATION STREET and LOOSE WOMEN star Sherrie Hewson has done us all a great service by speaking out about living with an underactive thyroid gland. Link

Penalty for maltreatment of patients? A Pension

From the UK's TIMES online, but we know that similar cases exist in Canada:
"In healthcare, social services and education, those responsible for shocking treatment of the public remain untouched and even flourish. The report on the scandal in Mid Staffordshire NHS Foundation Trust points to up to 1,200 unnecessary deaths, including four from one family alone within 18 months. Patients were left lying on the floor in their own filth, sobbing with humiliation. But not a single individual has been publicly blamed in this officially “elite” NHS organisation. Indeed, Martin Yeates, its former chief executive, has since left with a £1m pension pot, six months’ salary and a reported £400,000 payoff."

Link

Perhaps this is a step in the right direction
Link

This article lists the salaries of some of the highest paid hospital and medical administrators in Canada.
Take a look and see if you think they are worth all that and a bag of chips - your taxes pay for this.
Is it possible that a pathologist makes about $10k a day?

The Patient of the Future

Doctors don't like it, but e-Patients - concerned and engaged health researchers and partners - are here, and more are coming.
And - unlike physicians of today - they haven't been educated by the pharmaceutical corporations.

There will be a lot, my friend.
More than can be counted.

How many?

Like the stars.
~ DANCES WITH WOLVES


Slideshow
e-Patients.net
e-Patients PDF

NYT: Holding Doctors Accountable for Medical Errors

From the article:

"Q. Has this erosion of trust had a detrimental effect on the patient-doctor relationship?

A. The chaos of everyone doing things their own way is incredibly dangerous, and it is that chaos which gets in the way of the relationship. You can make health care better, safer and less expensive while strengthening the core of the patient-doctor relationship. You can standardize certain parts of care based on clear evidence, which will free up doctors to focus on those pieces of the health care puzzle where there is no data — those issues that are uniquely human and that require judgment, expertise and empathy.

The challenge, though, is to standardize care in a way that will improve safety while retaining the parts that make medicine human. The last thing we want to do is to regiment empathy or to create something so regulated that doctors cannot do something nuanced or innovative for patients.

Q. What are the roles of patients and of doctors in the patient safety movement?

A. If I were a patient or a loved one, I would do what everyone recommends — have a loved one by your side, look for signals that a hospital is safe, check that a physician is board certified. But I am also intensely ambivalent about how responsible patients should be for safety and the prevention of error. Medical mistakes are our bad. Why should patients bear the responsibility to receive the right medication or to have the correct leg amputated? When I get on a plane, I don’t worry about safety and errors.

As for doctors, patient safety can’t happen if physicians aren’t smack in the middle of it. We can either facilitate safety or we can stand its way. We will stand in its way if we embrace our historical approach to these problems, if we instinctively engage in finger-pointing, if we aren’t willing to listen to others.

We have a huge role in creating the kind of environment where people will feel comfortable questioning anything that seems strange or out-of-place and where doctors are open to different opinions from others.

As doctors, we have to admit first that we don’t deliver care that is of the quality and safety our patients deserve. Then we have to get past our professional arrogance. We don’t have the answers to all of these issues, and we have to be open to others who may have the answers or who can approach it from different angles."

Link

Patient Empowerment in Medicine

Many medical professionals are often years behind in their reading; understandably they don't like empowered patients.

Some doctors don't like patients who challenge them. Such patients take time and make a doctor work hard. Most doctors want to be considered the authority - even if it kills you.

If you see annotations in your medical file - "patient is getting information from the internet" - it is probably time to move on for the sake of your health and wellness.

Link

Pristiq for Menopause?

If you are a middle-aged woman and your primary care physician or endocrinologist is offering you antidepressants for symptoms, this article
on the marketing of Pristiq may explain why.
Make sure you have your thyroid checked... menopause troubles may be myxedema.

Teenage Children and Other Abnormalities - Laughable Excerpts from Actual MD Notes

Teenage Children and Other Abnormalities - Laughable Excerpts from Actual MD Notes

This list is reproduced from MDs' actual writings on charts, published in the Mpumalanga Hospital Register (South Africa), courtesy of Veven Bisetty.

It contains a memorable thyroid notation.

1. The patient refused autopsy.

2. The patient has no previous history of suicides.

3. Patient has left white blood cells at another hospital.

4. Patient’s medical history has been remarkably insignificant with
only a 11 kgs weight gain in the past three days.

5. She has no rigors or shaking chills, but her husband states she was
very hot in bed last night.

6. Patient has chest pain if she lies on her left side for over a year.

7. On the second day the knee was better, and on the third day it disappeared.

8. The patient is tearful and crying constantly. She also appears to
be depressed.

9. The patient has been depressed since she began seeing me in 1993.

10. Discharge status: Alive but without my permission.

11. Healthy appearing decrepit 69-year old male, mentally alert but forgetful.

12. Patient had waffles for breakfast and anorexia for lunch.

13 She is numb from her toes down.

14. While in ER, she was examined, X-rated and sent home.

15. The skin was moist and dry.

16 Occasional, constant infrequent headaches.

17. Patient was alert and unresponsive.

18. Rectal examination revealed a normal size thyroid.

19. She stated that she had been constipated for most of her life,
until she got a divorce.

20. I saw your patient today, who is still under our car for physical therapy.

21. Both breasts are equal and reactive to light and accommodation.

22. Examination of genitalia reveals that he is circus sized.

23 The lab test indicated abnormal lover function.

24. Skin: somewhat pale but present.

26. Large brown stool ambulating in the hall.

27. Patient has two teenage children, but no other abnormalities.

Note: This information may not have been evaluated by the FDA.

What Exactly Are They Teaching in Medical School?

What Exactly Are They Teaching in Medical School?

Dateline: 05/05/97
In the May/June issue of Health magazine, there's a familiar but frightening story. The article by Barbara Bailey Kelley describes a woman who had constant fatigue, constipation, constantly feeling cold and difficulty swallowing. According to the article, this group of symptoms had the woman "hopping from doctor to doctor. None could identify a medical problem." Three years after her symptoms appeared, the woman was checked into a hospital, where a coterie of specialists -- an allergist, heart specialist and psychiatrist -- examined her. The psychiatrist wondered if she was suffering from depression. After a battery of tests which, WHEW, finally included a thyroid-stimulating hormone (TSH) test, they FINALLY discovered that she was very hypothyroid, in fact, her thyroid had almost shut down completely.

Okay, calling Dr. Kildare! Marcus Welby! The entire staff of St. Elsewhere, Chicago Hope and ER! Where are the doctors who recognize thyroid disease's symptoms quickly?

On an AOL chat a few weeks ago, a group of us were speculating what would happen if a woman with a basketball-sized goiter walked into the ER at "ER." We decided she'd be told she was stressed out, and sent home with a prescription for Prozac, AND a big fat bill from the emergency room (that her insurance company would probably deny!!!) Now how bout that storyline for dramatic tension? (Of course we all agreed we'd keep the goiter if it meant George Clooney'd be our endocrinologist!)

In any case, doesn't it seem like anyone who's spent more than five minutes reading anything about thyroid disease would have a problem recognizing the familiar litany of symptoms the poor woman in the article described? In fact, I sometimes have to watch about becoming too evangelical myself when friends say, "you know, I've been feeling a bit tired and run-down lately, and..."

"COULD BE YOUR THYROID!!!" I announce.

Continues at Link

Planetree: Patient-Centered Care

Patient-Centered Care Awareness Month

"Patient-Centered Care Awareness Month is an international awareness-building campaign that occurs every October to commemorate the progress that has been made toward making patient-centered care a reality and to build momentum for further progress through education and collaboration. Hospitals and health care organizations around the world are encouraged to celebrate by empowering patients, strengthening their patient-centered practices, and publicly proclaiming to their patients and communities their commitment to patient-centered care.

For the past two years, health care organizations around the United States, Canada and the Netherlands have celebrated Patient-Centered Care Awareness Month. In addition, fourteen state governors commemorated the month signing proclamations officially recognizing the importance of patient-centered care to their states’ citizens.

What is “Patient-Centered Care”?

Although the phrase “patient-centered care” is defined and used in a variety of ways, the essential theme is the importance of delivering healthcare in a manner that works best for patients. In a patient-centered approach to health care, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences.

Organizations practicing patient-centered care recognize that:

A patient is an individual to be cared for, not a medical condition to be treated.

Each patient is a unique person, with diverse needs.

Patients are partners and have knowledge and expertise that is essential to their care.

Patients’ family and friends are also partners.

Access to understandable health information is essential to empower patients to participate in their care and patient-centered organizations take responsibility for providing access to that information.

The opportunity to make decisions is essential to the well-being of patients and patient-centered organizations take responsibility for maximizing patients’ opportunities for choices and for respecting those choices.

Each staff member is a caregiver, whose role is to meet the needs of each patient, and staff members can meet those needs more effectively if the organization supports staff members in achieving their highest professional aspirations, as well as their personal goals.

Patient-centered care is the core of a high quality health care system and a necessary foundation for safe, effective, efficient, timely, and equitable care."

Link - at the bottom of the pagte you can download their patient-centered care Toolkit.

DHEA, Adrenals and the Thyroid

DHEA is an endocrine hormone necessary for the function of adrenals. If thyroid is given without taking this into consideration, an adrenal crisis may result.
Does your endocrinologist know and understand DHEA?
Link
Link