Great Expectations
Whether it’s planned or an emergency, before you head to the hospital, check out your expectations before you check in.
You’d have to be practically dead to think an ER doctor would drop what he’s doing as your gurney comes flying through the hospital doors, says Dr. Maurice Ramirez.
But that’s just the fantasy rapid-fire TV shows like “ER” paint and the ideal we’ve come to believe, says the Orlando, Fla.-based doc who teaches emergency preparedness to businesses.
“You have to go through some process of sorting, called triage,” Ramirez says. By the time the doctor arrives, “unfortunately it means I’m not slowing down to stop for the family, either. I’m there to save a life.”
At this point, being shunted aside, the family is offended. This is just the beginning of a series of misunderstandings of what a hospital stay is supposed to entail. Medical staff are likely to hear comments like, “Well, the doctor didn’t talk to me,” to which the doctor might respond, “Well, you were dying. [I] talked to you as much as you could be spoken to.”
Ramirez blames hospital marketing efforts for creating unrealistic expectations about emergency room care and hospital stays.
“They’ve created the expectation that you’re going to push a call button, [someone will] appear in a puff of pink smoke, blink and all of your rights, wants and privileges will be granted, and you will be allowed to make every health care decision; we are there to serve you,” he says.
“That’s great if you were running a five-star resort,” Ramirez continues. “The purpose is to help people recover from surgery or injury or illness in the best possible environment.”
The American Hospital Association’s Patients’ Bill of Rights promises everything from high-quality hospital care and a clean, safe environment to involving patients in their care and help leaving the hospital. But somewhere between those standards of care, many patients and families are left wanting.
Flirting is what Jeri Cartwright resorted to in 2001 when her mother checked into the hospital for heart surgery. That was her way of getting answers about the status of her mother’s care from what she perceived as a burned-out, unresponsive staff.
“I had to ask about their lives, to get to know their lives,” the 52-year-old, Salt Lake City, Utah-based communications consultant recalls. “I had to shamelessly flirt with one of the male nurses, and based on my flirtation,” the way her mother’s medication was given was affected. “I had to do special things to keep their attention.”
While Cartwright’s mother bounced back, she worries about who’ll advocate for her if she must be hospitalized in her later years: “There are a lot of us in the boomer generation, and we decided not to have children,” says Cartwright, who wishes she had an medical advocate to watch out for her mother’s interests, especially since Cartwright lost money by being away from running her small business.
Now that you mention it ...
Fortunately, there is an expert who can advocate for patient interests. It’s called a hospitalist, a general practitioner who can speak the language of specialists and attending doctors while comforting and relating medical-speak to patients.
While a person’s family doctor typically would accompany them to the hospital and check in daily, “there’s no way any one individual can do a good job running backward and forward,” says Dr. Chris Nussbaum, a Tampa Bay, Fla.-area hospitalist who founded Synergy Medical Group.
The number of hospitalists is growing rapidly, according to the Society of Hospital Medicine. As of 2005, 8,000 hospitalists operated in U.S. medical centers, up from 800 in the mid-’90s, with a projected number of 30,000 by 2010.
With the typical patient, Nussbaum pulls up a chair to make her aware of what’s going on and what medical personnel are doing: “We don’t have set appointments; we can devote as much time as needed.”
“Hospitalists are embedded in the hospital culture. That’s a powerful situation for the patient and the insurer as well, because patients spend less time in the hospital,” says Nussbaum, noting that hospitalists may be paid from among many sources, including insurers, a patient’s family doctor or the patient herself.
A hospitalist comes in handy as a director in a “complex medical symphony” for people who have multiple ailments, Nussbaum says. He describes a patient, who among his many illnesses, is morbidly obese; has diabetes; chronic lung disease; testicular cancer for which he had radiation; and gastrointestinal bleeding.
He’s the doctor among all of the doctors/specialists treating this patient who can speak their lingo and relate it to the patient and his family. Depending on how one procedure will affect future procedures, such as controlling bleeding, Nussbaum will help the medical team decide on a plan of action that’s best for the patient.
“In this age of superspecialization, having someone specialize in being a generalist and to synthesize it into something the family understands,” is crucial when specialists tend to have “a narrow viewpoint. All have their role to play, which ultimately is not taking care of every single thing.” And, of course, this patient’s mental needs must be tended to.
Have a game plan
When Rodney Ross’ 87-year-old father, a former Tuskegee airman (the distinguished black World War II U.S. Army pilots), was hospitalized Father’s Day 2006 with an excruciatingly painful abdominal blockage, he and his two brothers developed a communications strategy. After all, the 55-year-old, Westfield, N.J., paralegal whose mother died a few years earlier, had a nerve-wrecking 10-hour drive into the night to reach his father’s bedside in suburban Detroit.
“What I did and what my brothers did was get our questions together beforehand so we didn’t waste the doctor’s time,” Ross says. “What did he come here with? What’s the prognosis? Is it likely to occur again?”
“I’ve found that doctors really appreciate if you’re a realist about what’s going on,” says Ross, who urges families to ask the right questions of the right people. For example, unless the patient is on a restricted diet, “the doctor can’t do anything about where the Jell-O is.”
Ross contends that certain categories of people, like the elderly or poor, might not get the best care because of the inability to communicate fully. “People simply don’t know or don’t tell something because they may be embarrassed or don’t think the doctor needs to know. What I’m thinking about is the older person who drinks. They must understand that their not telling does more harm than good.”
Ramirez suggests visiting your local hospital before you’re forced to check in.
“Come in as a tourist, meet the vice president of nursing, sit down with the hospital administrator. It could be an all-day event for senior citizens,” adding that pregnant women and others could benefit, too.
The case of the missing Popsicle
Still Ramirez, a certified medical review officer, says, in addition to miscommunication, mistakes do happen in myriad ways. In one case of a patient’s whose stomach was pumped for several days, the attending physician lifted her dietary restrictions to allow a glass of water one day and a Popsicle the next. Neither ever arrived. After a week without food, a Popsicle never looked so good.
This happens all the time with medication, Ramirez says. A doctor might write an order, but it’s illegible. It might be readable, transcribed correctly and sent to the wrong patient. The order could have been entered into the computer wrong. It could have been entered right, but the dietary staff mistakenly took the medicine, or the Popsicle, to the wrong room.
Remember, Nussbaum says: “If you have a good physician, they will let you know what their limitations are. They have your safety and comfort foremost in mind. You’ve got to have faith and trust that this person is trained in a special thing.”
Ross, whose dad has recovered and is leading kids on walking tours of the Tuskegee Airmen’s experience, says, “Deal with people according to the task they’re there for. Don’t treat nurses like waitresses. Use common sense. We all work; how would you want someone to approach you for information?”
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