Current Topic of Discussion


            This is true whether you are a patient in an office or a hospital.


                                             WHAT IS AN ADVOCATE??

    An advocate is someone who watches all the players and makes sure

                                        all the pieces fit together.


Medicine has become so disjointed that no one really is making sure everything is monitored. This is true whether you are getting care in your PCP’s office, are admitted to a nursing home (SNF) or assisted living facility (ALF) or hospital. There is no continuity today in any of these arenas and it can cause lots of problems. Like WHAT you ask.

Patients who are regularly ill and have multiple medical problems can end up circling between their primary doctor’s office, a hospital and a nursing home. Since few primary care doctors -- family practice or internal medicine—admit to, or take care of, their patients in the hospital anymore they have limited information of what is happening to them while inpatient. They are at the mercy of “the system” to get your inpatient records (timely or not). Hospitalists do most admissions and hospital care these days; they are often in groups who work together and they split call. This means you might not see the same “primary attending” physician every day that you are in the hospital. In fact, you might not even see a physician; this is because many hospitals use midlevel providers (ARNPs and PAs) to do this care. As an aside, I am against this practice and this is why. Patients admitted to a hospital or SNF these days are sicker with multiple medical problems, yet they are often cared for by “providers” who are ARNPS or PAs that have less training and education. So just when a patient is sicker they are cared for by someone who has less education and training;  they have a 2-D picture of health and physicians have a 3-D picture (in my opinion).

Then you will likely see several “specialty consultants” depending on your reason for being in the hospital; these are likely also midlevels. When I read their H&Ps and discharge summaries I always enjoy it when I see where they (the midlevel) documents that “patient seen and evaluated with attending” and “H&P or Discharge summary done in presence of attending” because they are not. The attending at some time has to sign the document but they were not even in the building when the document was dictated.

 Everyone looks at their piece of the recipe only for the most part and even the attending who is supposed to watch the whole picture isn’t paying attention. Add to that the fact that physicians are no longer the “captain of the ship”. We do not have any authority over the other hospital employees. We are with the patient for a brief period of time daily but the other staff is there for at least an entire shift. Your care is really in the hands of the nursing staff, cleaning staff, lab and diagnostic staff, etc. If they are not paying attention, cleaning their hands correctly, reading and interpreting orders correctly and following orders correctly then problems happen.  What do I mean?

1. Bed alarms are only as good as the amount of staff present that are paying attention and will come when they hear the alarm go off. If not, you fall and possibly injure yourself.

2. Are you being delivered the correct diet and are you able to feed yourself? Can you reach it? Often the tray is brought in and placed on the movable stand and left there. If you can’t reach it, open everything and feed yourself, drink by yourself then you will get weaker and sicker. You might choke on something. You might be given the wrong type of food. Drinks are notoriously left on the tray but the patient is unable to drink by themselves. They get dehydrated and get sicker.

3. Are you being given the right medications, at the right time and right dosing? Now I know there are all sorts of checks and balances in place these days to prevent these problems, but trust me, they don’t work unless the human aspect is in check; often it’s not. The only cure for human error is not to use humans. Add to that the fact that you can’t teach common sense. Be afraid, be very afraid.

4. People come into your room for lots of reasons and they bring disease in with them. Physicians are the worst for hand hygiene but no one wants to say anything to them. Soap and water is the best; those gels give a “lick and a promise” as my grandma used to say. People who come in to do procedures stand between you and infection. Someone needs to be there to stand up to them and demand care and cleanliness! I can’t count the number of infections I’ve seen from a peripheral or central line and usually its lack of specific and appropriate care that causes it.

The bottom line is no one is watching the ship and so you need to be and if you can’t then you need someone who can. If you must, then hire someone. Advocates are out there and I am available to do this for you. Hire someone who knows what to ask, who to talk to, what to watch. This pertains to hospital, nursing home, assisted living facility and office.




A web site that anyone with addiction in their surroundings should look at: www.reachoutrecovery.

 What is addiction?

 What can we do about it?

 Who suffers from it? 


What is addiction? Those who have seen it know it as the saying goes. Stedman’s Medical Dictionary describes it this way: habitual and psychological dependence on a substance or practice that is beyond voluntary control.

A person can be addicted to many things; including work (my hand is raised), alcohol, drugs (includes tobacco), sex, food, shopping and gambling to name a few. It’s the drug addiction that usually gets the spotlight but like all addictive behaviors, it affects all in the surroundings to the addicted person and therefore has an effect on more than just the person who has the addicted behavior.

There are numerous programs to help those afflicted by addiction but whether they work or not depends on so many variables I will not count them. So what about the repercussions of addiction? Well we all know if it involves illegal activity than it takes on a life of its own and had more than a passing effect of those around the addicted. Let’s take drugs for an example. It’s illegal in most places so the legal potential is huge. You get caught and go to jail. So there’s a record. Then you need bail and a lawyer and in some cases a place to stay. You might lose your job or relationship over it, and possibly the ability to see your children both short term and long term. There is the physical affects from drugs that usually are long lasting and these can cause their own problems. If you’re driving under the influence you might have an accident injuring yourself, others and/or property. We have a huge pyramid of effect now and I’m only talking about drugs. I think you can all spin the other addictions in similar algorithms.

The medical community has dropped the ball on this one and the insurance companies have added the wall beyond which we cannot move. Treatment is key but since the early 1990’s with the advent of HMO medicine, getting medical benefits for mental health care is a joke. We know insurance companies don’t want to spend money; they want to make money. And HMOs are worse. They agree to take the premium, provide services and take a cut off the top for their “need to make a living.” And boy what a living they are making. I’d call it a killing but I digress. Is the surge in gun-related killings and the fact that these gun-toting people are mentally ill related? Yeah!!

Everyone understands that mental health issues are not easily fixed or treated and so require long term care. That’s where insurance companies bail on us. I think we can all trace the upsurge in mental health issues to the early 90’s when insurance companies and their HMOs cut off the benefits needed and problems resultant climbed. As my Grandma used to say “they’re giving it a lick and a promise”. You get three days of treatment and then “here, take this pill”. While medications can help, they are not the answer. Sometimes the treatment is many sessions of talking to someone who knows how to help the afflicted through the maze of the problem. And to those out there responsible for paying the treatment bill, who are complaining, I say this: ”pay me now or pay me later”.