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Get Smart


 

In YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment, authors Michael F. Roizen, MD, and Mehmet C. Oz, MD, well-credentialed celebrity physicians, tell the reader that being a smart patient may make the difference between good and poor care and may even save your life. Everyone can be a “medical detective,” they suggest, seeking and supplying the facts that providers and administrators need in order to avoid errors or mix-ups.

The Joint Commission Resources, a collaborator on this publication, announces on its Web site that this book “empowers patients” (www.jcrinc.com/generic.asp?durki=11727&site=11&return=405.). Dr. Oz, in a Web post to customers who might purchase the book, puts it this way: “[T]he Joint Commission, our nation’s healthcare safety advocate, approached us to help with a big problem. Medical errors cost us 98,000 lives per year, and the Joint Commission could not squash this crazily large number without pulling in the biggest ally of all, the Smart Patient.” It’s a “scary statistic,” but true, he writes, “You have a two in five chance of being affected by a major medical complication in your life.” (For more information on the book, visit www.amazon.com/YOU-Insiders-Handbook-Getting-Treatment/dp/0743293010.)

The Hospitalist asked some hospitalists what they would recommend to a friend or relative headed for a hospital stay. Do they have any tips that only an insider would know? As might be expected, some of their advice echoes that already available in print, in broadcasts, and on the Web. And some things that were mentioned in these publications were also on our hospitalists’ list, including bringing along statistics, dates, and other healthcare specifics that might be crucial to providers. In fact, Drs. Roizen and Oz recommend assembling a thorough health history and bringing two copies of it to hospital admission—one especially for “the admitting nurse who welcomes you to your bed.”

Assume Nothing

In their book chapter on hospital stays, Drs. Oz and Roizen emphasize that patients and their visitors should keep an eye out to make certain hospital staff wash their hands and give the patient the right treatments, tests, and medications. “It’s astounding the amount of diligence you and your family will have to exercise during a hospital stay,” a reader-reviewer writes on the book’s Web page on the Amazon.com site. Some of the warnings posted in a book excerpt at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)’s site include “Don’t touch that remote!” and “wear rubber gloves” if you do want to watch TV. Readers are told that “a study found that the TV remote control is one of the most germ-infested things in a hospital room.”

Patients are also cautioned to “insist on being scanned,” to “insist on a clean stethoscope,” and to keep “an industrial-sized jug of alcohol hand-sanitizing gel” by the bed. In fact, the authors write: “Stethoscopes are filthy from being used on several patients an hour. Most doc[tor]s now wash their stethoscopes with alcohol between patients, but we’d always ask.” Our hospitalists agreed.

Ian Jenkins, MD, a hospitalist with the University of California at San Diego, would tell his friends and family to remind providers to wash their hands. “Don’t let anyone touch you unless you’ve seen them wash or gel their hands correctly—and their stethoscopes, too.”

Drs. Oz and Roizen say, “You might even post a sign that reads ‘Thank You for Washing Your Hands’ as a gentle reminder.”

Trust your intuition, one hospitalist tells people facing hospitalization. “If you sense that something is awry, it probably is,” says Jeanne Farnan, MD, a hospitalist scholar at The University of Chicago Hospitals. “Discuss concerns with physicians/nurses. Write down your questions in case they come to you spontaneously.”

On the other hand, she tells friends and relatives, “Patients, when asked questions, will often respond, ‘it’s in my chart.’ We often don't have access to a primary MD’s notes/chart, and not all documentation is pristine. When we are asking questions regarding your medical history, it is only to provide you with the best care—not to be a nuisance.”

All patients, but especially the elderly, says Dr. Sachdeva, should have a patient advocate with them at the hospital … someone who can be there in the room and ask these questions: What medicine are you giving me? What’s the next step? What are the options?

Be Selective about Your Providers and Hospital

One recommendation from JCAHO’s patient education Web pages is a section entitled “Finding Dr. Right.” “Choose wisely and you could rest easy for many years to come,” it says.

Sandeep Sachdeva, MD, lead hospitalist at Swedish Medical Center’s Stroke Program and clinical instructor at the University of Washington at Seattle, says this may apply even to a patient’s relationship with a hospitalist.

“Sometimes patients come in and tell us their stories [about how providers treat them]. It’s just amazing; I think patients who have family members providing close supervision seem to get better care than somebody [who] is not asking questions,” he says. “And some care providers find questions intimidating, but the patient should not get discouraged by that. … If they feel that the care provider is not listening to them or not being attentive to them, they can always have a recourse: They can talk to the supervisor of that provider or somebody else [to get] a different provider. Patients sometimes have the fear that if they speak up against somebody that their care might be jeopardized.”

Dr. Sachdeva advises friends and relatives that they talk to the nursing supervisor or ask for the physician supervisor or an administrative person or social worker so that they get the attention they need.

Dr. Jenkins agrees. “Informed consent” is one of his tips for friends and family: “If your doctor won't talk to you about the risks and benefits of your treatments, and alternatives to them, you need a new doctor.”

Our hospitalists suggest being discriminating, savvy, and proactive:

  • “Find one hospital you are comfortable with, [where] your family physician is on staff, and use it exclusively if possible,” says David M. Grace, MD, a hospitalist with The Schumacher Group in Lafayette, La. “By utilizing one hospital, all of your previous records and test results are immediately available when needed. Often this translates into a much shorter hospitalization as there are no delays in obtaining old records, and it minimizes the chance of duplicate tests/procedures being performed.”
  • “Know who your doctors are [and] what their role is, and understand their input into your healthcare,” says Dr. Farnan, who is extensively involved in medical residents’ training. And “be cognizant of the physician work hours,” she advises. “We often have families who demand to speak with ‘their’ doctor at all hours of the early morning and night.” She tells friends and relatives, “I think more patients need to understand the nature [and] structure of the system [and] what kind of information a covering physician can provide. If the family of the patient has questions [and] wants to speak with the primary MD, it may be best to attempt in the daytime when the primary service is more likely to be present.”
  • “Know the full names, and preferably [the] phone numbers, of all your outpatient physicians,” says Dr. Grace. “One area will often have multiple doctors with the same last name, and, frequently, records need to be requested from them. Up-to-date contact information on your physicians helps us request the right records from the right physicians with minimal delay.”

What to Bring to the Hospital

Some hospital Web sites advise patients on what to bring with them for their hospital stay, suggesting everything from your own robe, slippers, pajamas, or nightgown to an advance directive. Definitely, the latter is an important point.

“Whether it’s an elective or emergent admission,” says Dr. Grace, “there are a few things [you] can do to ensure [your] hospitalization is as safe, efficient, and productive as possible,” he tells friends and relatives. Among them, he says, is to “have a Living Will or advance directives completed, ensure the hospital has a copy, and discuss your wishes with your family prior to admission. Clear and concise plans, coupled with good family awareness, will help ensure your wishes and values are honored appropriately.”

And, as several of his hospitalist colleagues suggest, “Bring all of the medications you are currently using, including any over-the-counter medicines and herbs or homeopathic treatments. It’s imperative that physicians know what medications you are taking [because] many cannot be stopped abruptly, and [they may] have interactions with medications you may receive in the hospital.”

In addition, “know what medications you’re truly allergic to [e.g., hives, swelling, breathing problems],” Dr. Grace advises, “and which medications you have had side effects from [e.g., stomach upset, sleepiness, and so on]. Many patients confuse the two. Occasionally the best or only option involves using medications with potential unwanted side effects. Rarely do we use medications to which the patient has a true allergy.”

Communication: The Key to the Hospital Kingdom

Dr. Sachdeva recommends being ready to communicate even before going to the hospital. “In the case of an emergency admission,” he says, “they should have all their information readily available because at the time for a needed hospitalization, they may be sick and confused.” Have it “on their person” or in “an easily identifiable place,” he says, and, like his colleagues, he reiterates that this information should include a list of medications, problems, doctors, and phone numbers, along with a list of patient advocates and their phone numbers.

“Most of the time, patients are able to notify a family member, but if that doesn’t happen, then the ER can notify the appropriate person to be present to supervise and oversee the care from a patient perspective,” he says.

Communication was mentioned by all the hospitalists we interviewed. “Be prepared to ask questions and take an active role in your healthcare,” says Dr. Grace. “Ask your nurse what each medication you receive is and what it’s for. Ensure you know what medications to continue taking when you return home and which ones to stop. If you don’t understand your diagnosis, prognosis, or treatment plan, make sure you ask.”

One hospitalist’s advice pertained to the patient’s and family’s behavior and is based on an experience in her own family: “Be really nice to everybody,” Alison Holmes, MD, a hospitalist with Concord Hospital, Concord, N.H., advises friends and family. “This is hard to do when you’re sick and scared, but it’s incredibly important.”

Dr. Holmes speaks of her own parents’ experience: “My mother was admitted to the hospital for pneumonia about a year ago. She had very long wait in the emergency room. My father got very upset and called me and said, ‘Oh, they were so angry at me, I was yelling at everybody.’

“That won’t get you anywhere!” I told him. “That will get you worse care.” I asked, “Where is she now?” and he said, ‘Oh, she’s still in the emergency room,’ and I said, “You’re at home? You left her there?” Dr. Holmes then advised her father to return to the hospital right away.

Finally, all the hospitalists we interviewed emphasized that they would tell their family members to designate a point person for communication. And you can’t assume that that would be their doctor son or daughter, even if they happened to be in the same locale.

“When possible, don’t stay in the hospital alone,” says Dr. Holmes. “Try to always have a family member present so that there is someone available for questions. It’s not always clear where [the physician] can reach someone or how far away [that person is]. It can take a little coordination and multiple people to do it,” she says.

Also, Dr. Farnan points out, “It is often difficult [because of time limitations] for [physicians] to repeat the same information to multiple family members.”

All patients, but especially the elderly, says Dr. Sachdeva, should have a patient advocate with them at the hospital. If they don’t have family close by, they should have “a close friend or neighbor who is willing to take on that job, someone who can be there in the room and ask these questions: What medicine are you giving me? What’s the next step? What are the options?”

Dr. Sachdeva advises relatives that they might be distressed or unable to focus, so having a healthy advocate with them may be extremely important, “the difference between life and death,” although, no doubt, he’d leave that last comment out of his advice to family. “Because a lot of the time, it is not that we don’t try to do a good job, but it’s just [that] the advocate might bring something to our attention that we might not have otherwise noticed.” TH

Andrea Sattinger has been writing for The Hospitalist since 2005.

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