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Ten Tips For A Safe
Hospital Stay
Sources by Amanda Bach
In 2003, Dr. Laura Nathanson was
widowed after the misdiagnosis of her beloved husband. After this tragedy, she
was
determined to help others protect themselves and their loved ones from
similarly preventable health care disasters -- and help them benefit from health
care miracles.
In
What You Don't Know Can Kill You, Dr. Nathanson provides a guide to getting the best medical care
and navigating our frustrating and often impenetrable health care system. In
clear, non-medical language, she shows how to:
- Flag any signs of
misdiagnosis and misleading analysis of symptoms
- Prevent miscommunication
among specialists from having dire consequences
- Stay safe in the hospital
and bypass its dangers· Choose a health care plan without falling into the
"uncovered services" trap
Full of empathy for each
individual patient and caregiver, What You Don't Know Can Kill You will
empower patients to be their own best advocates.
We’re going through a
sticky patch in hospital care. Patients and their loved ones often feel that
there are too many doctors (and you rarely see the same one twice) and too
few nurses (and it’s hard to get their attention). Worse: it’s hard to
figure out just who is in charge -- or whether anyone is. Here’s why:
Too
many doctors:
Many hospitals are Teaching Hospitals. That means that medical students,
young MD’s not yet licensed to practice, (Residents), and practicing doctors
who are earning a Subspecialty degree (Fellows) all contribute to patient
care. And all of them work
under the supervision of a fully qualified Specialist or Sub-specialist. Many
patients have complicated conditions and a resulting profusion of doctors in
various stages of training.
All these doctors may appear at your bedside, individually or en masse. They
rotate in shifts that are shorter than they used to be; your daytime doctor
is unlikely to be your nighttime doctor. And they change crews as often as
week to week.
Nobody
in charge:
If you have only two doctors, they need to communicate only with you and
with each other. If you have three doctors, there are six crosspaths for
communication. If you have six doctors, there are potentially 720 types of
doctor-doctor communication. Nobody checks that every such communication
takes place and is accurate.
Medical specialists often
vie with each other for decision-making power. Who decides if the lung
abscess needs antibiotics, or surgical drainage? The lung doctors, the
surgeons, or the infectious disease specialist?
Just to top it off, many
hospitals now employ their own Hospitalists -- physicians who are charged
with being the final decision maker at the patient’s overpopulated bedside,
able to overrule a Specialist’s and or a Primary Care Doctor’s
recommendations.
Too few nurses:
We are coping as a nation with a severe nursing shortage. Even if lots more
people were eager to become nurses, there are fewer and fewer expert
Registered Nurses around willing and able to teach them.
So nurses may not only be
few and far between, but exhausted by longer shifts, higher patient loads,
the paperwork demanded by Managed Care and the Joint Commission, (a private,
non-profit watchdog for hospital standards,) and the rapid development of
new skills for them to master.
What
can be done?
The fall out from these
developments can be serious: errors and delay in diagnosis, dangerous
glitches with medication and care techniques, and oversights in ordinary
patient safety.
Here are my suggestions
for staying safe in the hospital:
1. Ensure that a
competent adult stays at the patient’s bedside, and goes along on trips
requiring wheelchair or gurney, as close to 24/7 as possible.
2. That adult should
serve as a Sentinel, alert to obvious deviations in care (food being given
to a patient who is supposed to have nothing by mouth, for instance);
ominous changes in the patient’s condition unnoticed by the staff (increased
trouble breathing, poor color, incoherence); and situations that are
dangerous, such as an unconscious patient who is vomiting and in danger of
aspirating the vomitus.
3. The Sentinel should be
prepared to perform tasks that free up the nurse for more sophisticated
patient care. Offer to empty basins and bedpans, sponge-bathe the patient,
tidy the bed, know where vomit basins, bedpans, towels etc. are located, and
how to help the patient put on a hospital gown. The Sentinel also may have
to call for, or even administer, emergency treatment, such as suctioning the
vomiting patient.
4. Ask every caregiver
not only their name, but their exact title. If you don’t know what the title
means (“I’m a first year fellow in Invasive Radiology,” for instance) then
ask (“What is a Fellow? What is Invasive Radiology?”)
5. Ask for the training
credentials of the Hospitalist. “Hospitalism” is not a specialty in itself;
there are no required credentials, no Board Certification in Hospitalism.
Your Hospitalist should be a Board Certified Specialist in the kind of
condition the patient has. If not, or if you’re not sure, call your own
Primary Care Physician.
6. Every student,
resident, and fellow works under the supervision of a senior,
board-certified physician. Ask each one who their supervisor is and the
nature of his or her credentials. If a surgeon-in-training appears at the
bedside to perform a procedure, make sure that the senior surgeon knows
about it and agrees to it beforehand (unless it is a truly urgent
situation.)
7. The potentially most
dangerous area of the hospital is the MRI suite. It contains an extremely
powerful magnet that acts on every magnetizable object in the room. Metal
devices or fragments inside the body can shift and damage tissue. Loose
objects in the room, such as an oxygen tank, will “home in” on the magnet at
great speed, regardless of what is in the way -- such as your head. Make
sure your technician has checked on all possible dangers. There are no
“national” guidelines for MRI safety.
8. Every study or lab
test performed is ordered to answer a specific medical question. For
instance, Is the bone broken? Is the pneumonia improving? Has the heart
suffered damage? If you don’t know why a test has been ordered, clarify it
and write it down. Once the test is performed, make sure that the physician
who “read” the results actually answers the question.
9. Wear a shrill whistle
on a chain around your neck, hidden under your top, to use ONLY in the case
of a true desperate emergency.
10. As soon as possible
after discharge, obtain and review the records of the stay with an eye
towards accuracy, logic, and the credentials of the physicians. Make sure
the reports of studies answer the medical question that was asked, and that
the reports of students and doctors in training have been annotated and
co-signed by the supervisor.
If this all sounds
daunting, well, it is. But after thirty years as a physician, and
sixty-seven days and nights with my husband in four different hospitals, I
can’t honestly offer less intimidating guidance.
It is likely to be
decades before we get medical care under better control, and in the meantime
it is up to us, the Sentinels of our loved ones, to become the crucial
missing member of the Health Care Team: that is, the person ultimately in
charge.
Copyright © 2007 Laura Nathanson
About the Author:
Dr. Laura Nathanson
is the author of
What You Don't Know Can Kill You (Published by Collins; May 2007; $15.95US/$19.95CAN;
978-0-06-114582-7) and
The Portable Pediatrician,
The Portable Pediatrician's Guide to Kids as well as several other books. She has practiced
pediatrics for more than thirty years, is board certified in pediatrics and peri-neonatology, and has been consistently listed in The Best Doctors in
America.
For more information, please visit
www.lauranathansonmd.com.
