Pray! Then for good measure, pray again; get put on the prayer chain at church
or other place of worship. Pray of course for your health, but just as importantly you need to pray that things
go smoothly while you are there, that everyone involved with your care is paying attention and everyone is doing their job
correctly. Despite the fact that failsafe mechanisms are put in place, accidents still happen—a
lot! I have actually seen hospital care get worse since I first started hospital training in 1984.
It got worse again once HMO medicine took over.
2. Next, have a personal advocate if possible;
even if you are assigned one in the hospital as part of your “team” and especially if you are assigned one. Keep
in mind that you are not their only patient. (Know who all the members of your team are and why they are there and why they
are on the team). This is more important if you are compromised in any way; by your disease, medications or other issues.
You need someone who can be there as much as possible for most of your admission time (get a relay team
of people) to make sure the healthcare providers are paying attention and doing what they need to do. Your safety is supposed
to be watched and secured by the hospital people, but trust me, have your own folks there to keep an eye on them. Not in
a malicious way, of course, but it is very important these days to have someone watching the ship.
You are the ship and the healthcare providers are other ships passing in the night. Your “watcher”
is the same all the time vs. the fact that you might not see the same doctor or midlevel provider
every day. They may be passing you off like a baton in a relay race. This is one of the problems
these days. Between hospitalists and specialty groups, you may not see the same primary doctor
or the same cardiologist, etc. they may read the chart, but things are often not completely correct in the chart and
the doctors often don’t actually talk much to each other. They may give each other “report”, but often
the nuances of your case are missed in report. You are just another patient on their list. But
you are the only you. Your advocate will know the running theme of what is going on and will
be more likely to see something out of order.
3. Who are your medical “providers”?
I don’t like that term. I am a physician, not a “provider”. Is your primary “person”
a physician, a PA (physician assistant) , an ARNP (nurse practitioner), or something else? This is important because they
all have different levels and types of medical education. Google and find out, but basically here is the short version.
A physician goes through college that is “pre-medical” in orientation. That means
we take a lot of science and math as the basis of our degree. Then we have 4 years of medical
school and then at least 3 years (depending on specialty) of postgraduate “residency”
training. A nurse practitioner is first a nurse, and there are various degree pathways, although all
RNs today go through a 4 year nursing program that includes some math and science, but not the kind physicians take (if
my information is correct). That training is predominantly compassionate custodial care, which
is very important but not the same as medical school training and education. Then they take graduate
level course, which may include a master’s program and then they take courses for the ARNP
degree. I think this may be 2 years and then some clinical training. A physician assistant comes
to that program with the possibility of a variety of degrees and need not include anything in the medical field. They
take 2 years of abbreviated medical training and then clinical training.
4. What are they saying is your “working
diagnosis”? What do they think is wrong with you and why?
5. How are they evaluating you for this
diagnosis? What tests or specialists are they having evaluate you, and why? You have the right
to ask these questions and understand their plan. You have the right to question this plan and any tests they want to
do. What are the potential side effects or adverse results from a procedure? An example:
if they want to do a thoracentesis (where they tap your lung to drain off fluid that shouldn’t be there) it is possible
to cause your lung to collapse sometimes).
6. Always ask what the alternatives to any procedure are (especially
if they want to do surgery).
7. Who is coming into your room, and why. Make sure they wash their hands in front
of you if they are there to touch you in any way. I am not a fan of that hand gel cleanser. I
like soap and water, and they should wash their hands long enough to sing Happy Birthday. I don’t
care if they say they washed their hands before they came into your room, make them do it again.
There is still, and even more so these days, a HUGE infection problem in hospitals; washing
hands can help a great deal and it isn’t done enough. Doctors are the worst for this.
If someone comes into your room to draw blood, know what for and make sure they have the right patient.
9. If someone comes into
your room to give you medication, know what the medication is, what it is for, and make sure they have the right patient.
Make sure they know your allergies. You have the right to refuse any medication. If they are changing
medications, know why and what the change is. If it is a new medication and you will be going
home with this new medication as a prescription, it may be expensive and may not be covered by
your insurance. Try to find this out before you leave with the prescription as getting it changed
after the fact may be difficult.
10. If you have a cultural or language communication issue, make sure
you have access to help with that. If it is a religious or cultural issue, please do explain it to your healthcare providers.
They need to, and want to, understand.
11. Are you having surgery? Make sure you actually understand what they plan to do.
What is the procedure? Why are you having it done? What are the alternative, possible consequences, side effects, adverse
effects, etc. While it is virtually impossible to give complete informed consent (you have little medical knowledge and
they have a lot and it’s hard to explain everything in terms that make sense to a non-medical
person), you have a right and a responsibility to understand as much as possible. Make sure all
your questions are answered as much as is possible. Remember, medicine is an art and a science;
it is not possible to list everything that might happen or go wrong, but they should be able
to give you a pretty detailed discussion. Physicians often do a speedy consent with patients. If the surgery is an emergency
make sure you have an advocate who can listen and understand and is not intimidated by the medical establishment.
You need to know and be well-versed in your own medical history, what medications you take and why, what you have previously
been given, etc. Let me digress here for a moment. Historically, and as background, physicians hear screeching tires when
a patient comes into their exam room with a rolling cart of medical files. Why, you ask. Because patients who do this expect
the physician to stop everything and look through all those files and know that you- the patient- expect that they will
give you their complete attention for whatever time it takes for you to go through all those records
with them. This simply isn’t possible or realistic. However, the information you have in
that rolling cart is important. I would suggest that you condense that information to a bullet
point list, if possible. Or you can condense it anyway possible and e-mail it, or mail it or
put it in whatever form you want that is realistically possible for the physician to review before or after and minimally
scan while with you. A competent physician appreciates that information. But remember, we are given an abbreviated period
of time to be with you; it certainly isn’t the time frame we would like. Think about putting this
information into a format that would be useful to you. “just the facts, ma’am”. Don’t
elaborate on how things made you feel. I know this is difficult because a patient’s view of medicine is different
from a physician’s view. And there are still many physicians out there with a paternalistic
point of view. We have been trained to look at a lot of information and condense it, whereas
as a patient you are afraid we won’t see what you want us to. I recommend you put that issue
on the top of the list as your most important issue.
13. Make sure the staff and/or physician
thoroughly explain results and other potential care. Don’t let them rush through it with you or your assigned
contact person. The medical personnel often forget because while they are in this environment all the time, they don’t
think about the fact that you are not; i.e. what is common place to us is certainly not to you. Be polite but stand up for
yourself, or have your advocate do it for you.
14. What will happen on discharge? Who are you
to follow with and why? Do you have a primary care physician? If not, you need one. Do you understand all
the parts of your discharge? The discharge is a very important part of your stay and for many reasons.
Often, problems here become another admission for you. First, if you do not have a primary care physician you need one,
and hopefully it is a physician that you can see frequently. By that I mean many physicians use
midlevel providers (physician assistants: PAs, or nurse practitioners: ARNPs). While these are
good members of the medical team, you often need the expertise of the physician, and you want
a primary care physician who will not pawn you off all the time on the midlevel. It is my opinion
that on your first visit you should be seen by the physician. Why? Because he/she is the head of the team, with the most
education, and your treatment plan needs to be established by the physician. If you have a complicated
history or medical problem you need the person with the most training initiating the plan for
Sometimes when you are in the hospital you see all new people because few primary
care docs do hospital rounds anymore; by that I mean they don’t take care of patients in
the hospital anymore. Therefore they don’t know what happened and the people at the hospital might not know what
your doctor knows. In short, there is not a lot of information exchange between offices, hospitals, rehab facilities, etc.
You must make sure that you can be the conduit of information for your safety.
Sometimes your medications may be changed. You
need to know which ones and why. Don’t let them just put you on the newest medication. Specialists like to do this
and they have no concept of cost. Make sure you look at the list of medications you came in on
and what you will be leaving with and why changes were made. Be sure to understand generic and
trade name drugs as I often find patients taking 2 forms of the same medication because they don’t
know the trade name and generic name. If you can’t do it, have your advocate label all meds
and separate the ones you are no longer using. But I, for one, do not believe that you should automatically
throw out the old medications. You never know when you might not tolerate a new medication and you end up getting put back
on the old medication.
Are you going to a rehabilitation facility? All the rules for the hospital hold true for
rehabilitation, and maybe more so, because your doctor most likely does not take care of patients
in rehab centers, and the people who took care of you in the hospital will not be at the rehab
center either. You will most likely have what we call “circuit rider” medical providers.
These will most likely by an ARNP “supervised” (means nothing as the doc is miles
away and never sees you and is in charge of what the ARNP does, or you have a doctor who doesn’t
know you) by a physician somewhere else. The administrators of the rehab center try their best to provide care with what
the insurers will pay and must take most of it back to the parent company as profits. You really
need an advocate here. There are many problems that occur in these centers, some can’t
be helped but many can.
As you can see, the world of medical care has come far from the
days of Dr. Welby. Medicine has become a “treat ‘em and street “em” mentality
even though most of us try our best to provide the best care we can. Most medical providers are honest, caring people
and we sacrifice more that you will ever understand to be there every day. The world of medicine
has changed so much, and much of it for the worse due to the production-line mentality created
by the insurance mentality of medicine. Pray for us as we care for your health care needs. It
is you and us against the medical insurance system.