How To Stay Safe While in the Hospital
From some one who has heard and seen his share of medical horror stories, a few recommendations on how to stay healthy and alive while in a hospital.
It is no secret that I believe that we as physicians do too much. More than is medically necessary. My biggest complaint is the abusive overuse of implantable defibrillators (AICD) especially in the
I have 90 year olds who have received AICD’s without any history of life threatening arrhythmias, a 50 year old I had been treated for a condition called a rate related cardiomyopathy, which means.that once we control the heart rate, the weak heart muscle should become normal again.
Just 2 of the several patients that have no medical justification for these $50,000.00+ devices. Get the picture?
Anatomy of a problem.
What you won’t hear in the main stream media is that hospitals are in business to make money. Hospitals today are different from the hospitals my parents knew or perhaps the hospital some of my older patients remember from a bygone era. A hospital used to be a place of last resort, where patients would be admitted by their family doctor, for treatment they could not receive at the doctors office. You came in for one problem, where followed by your own physician, treated for that problem and quickly discharged home under the care of your doctor.
They used to be referred to as community hospitals, many run by nuns and religious organizations. All needing people were accepted regardless of ability to pay, because hospitals existed to provide a service to the community.
Today things are much different. Hospitals are no longer community institutions that care for the people, the masses. Hospitals are a multi-billion dollar a year business, enterprises, many of who are owned by for profit corporations, and hospital chains such as Tenet, Hospital Corporation of America (HCA) and Baptist Health System just to name a few. Corporations run and manage hospitals and a shift from patient care to care of shareholders has occurred. With this for profit shift, hospitals stopped focusing on community and instead morphed into becoming Centers of Excellence of some kind. Whether it’s a Bariatric Surgery Center of Excellence, advertising directly to obese, overweight consumers to Cardiac Centers of Excellence where patients should come to have all their cardiac needs addressed by their highly trained, highly specialized, Board Certified cardiac doctors. Find a gimmick, find a niche and increase profits.
Just turn on the television on any afternoon, especially during the local news hour (their marketing department has figured out this is an ideal time for their target demographics) and count how many hospital advertisements you see.
This is one reason why healthcare costs continue to increase, is the inappropriate and over utilization of medical services. It happens daily, I see it commonly and I am sure either you have had or know of someone who has had a similar experience.
A paradigm shift as drastic as change from a “Marcus Welby” type of experience to one of “House”. From warm, nurturing, caring individual centered care to high tech, fast paced, cold, and impersonal setting.
There used to be a time in medicine, not too long ago, when we practiced differently. Consider it a common courtesy or good medical practice or perhaps even an expected practice which ever the case may be, but it was expected, that whenever a patient came to an emergency room (ER) for evaluation, that the patients doctor, the family physician or physician who has been treating the patient would be called and notified of the patients arrival in the ER. In addition to serving as a professional courtesy, it more importantly served to help the ER doctor learn more about the patient he was treating in his ER. Who better to obtain additional, important and relevant medical information, useful in making a more complete assessment of the current situation, than the doctor who has followed and known the patient. For example, a patient may have an arrhythmia of some kind or chronic angina (chest pain), long standing cough or an abnormal looking EKG, there are many situations that are chronic and old in nature that don’t need emergent assessment or management, but that may be of concern for the ER doctor who is unfamiliar with the patients complete medical history. By calling the patients doctor, the new ER physician can learn a vast amount of information and be advised on conditions and complaints that are old and chronic. Often times the patient had already been evaluated and treated and as a result, better quality decisions can be made for the patient.
This is the way I practiced medicine while I worked as an ER physician during my Fellowship as a result of being taught and instructed by physicians who preceded me.
Communication and professional courtesy existed and it played a vital role in improved patient care and outcome. Not so anymore. Many of my patients who inappropriately received devices and interventions where done at local area hospitals that could have easy called my office, reached me, yet did not. On many occasions my patients informed the ER staff of my name and phone, but where told that I wasn’t on staff and I would be assigned to someone else. This unfortunately for patients has become the new standard of care. Admit, don’t notify or ask the primary, family doctor of the patient in the ER, admit and start the process of work up and evaluation irregardless if it is not an acute event. We’ll just admit with a diagnosis that will get reimbursed and do what you please. This is the case as long as the patient has some kind of insurance. No insurance, then they do the minimum evaluation, make sure you’re not acutely ill and send you out as quickly as possible.
Another change from the past: Hospitalists
In addition to the hospitals’ for profit business nature, now a days, physicians are either too busy or don’t have all the privileges needed to follow their own patients should they be admitted to the hospital.
As a result not too long ago a new field in medicine was created called the Hospitalist. These are doctors, the majority of whom are employed by the hospital itself or by corporations who have a contract with the hospital, to provide in patient care for patients. Here is another opportunity to be treated by another new doctor who doesn’t know anything about you. As a result there is more chance of more testing to be done on you than needed. I will never understand how it is that a patient gets admitted with one diagnosis or one problem, yet during the hospitalization seems to be evaluated by a battery of different consultant specialists and be treated for multiple problems. Somehow, someway, many different things are discovered and as these doctors who don’t know anything about the new patient start on an investigative course that prolongs stay, increases costs, increase the number of tests and interventions all of which add to decreasing quality and patient safety. Patients go in with a pain in their toe that does not need admission, and leave several days later with an AICD (this actually happened to one of my patients). I must also mention that most of my patients that ended up with an inappropriate AICD, had them placed while at hospitals that touted themselves out to be Cardiac Centers of Excellence. Not only should this make you wonder what is happening in medicine today, it should be a wake up call for regulatory agencies and another reason why I am writing this for you and your protection.
Staying Safe
Become ProActive., Be your own healthcare Advocate OR
have a friend, family member be your advocate for you if you cant.
No one will take better care of yourself than you. Do not trust that a hospital or and I am sad to say, but especially don’t trust that a new doctor you have been assigned will have your best interest at heart. This again comes from my personal experience and being on the inside seeing what happens. It is frightening.
The good news is you can receive excellent care if you don’t become a patsy and a follower of what is told to you.
Remember that the time to prepare is before you find yourself in a hospital. When I ask my patients why they allowed a doctor to do as many tests or do procedures and put in devices, overwhelmingly I hear the same thing. “I was in a hospital, I did not know what was happening, these doctors told me I needed the tests, procedures, pacemakers, who am I to say no?” In the hospital as a patient, you are in a very vulnerable position. This is not the time to try and figure things out. Everyone knows that and that is why abuses and overuse happen.
1). Speak with your doctor about where he/she admits patients to. Ask if he has an associate or colleague that can follow and treat you if you need top be hospitalized.
2). The best advice to offer is for you to make and keep your own mini medical record and information and include copies of EKG’s, latest Xray reports and especially any unusual lab exams or reports you may have. Just because someone has a test that is unusual or not typical of the norm, does not mean that you have a problem.
Quick example. As a cardiologist I treat patients with heart conditions. One condition is called “hypertrophic cardiomyopathy” which basically means the patient has a thick heart muscle. This thickness causes a very abnormal looking EKG. If a new doctor or a doctor that has never seen or treated you where to see this type of EKG, unaware of the pre-existing condition, you would be hospitalized into the Intensive Care Unit and receive a battery of testing and evaluation. So in this case, although you have an “abnormal” EKG, it’s normal for you and we need not worry about or address it any differently.
3). Become familiar with your medical condition(s) and state. Do you have a medical condition such as diabetes, hypertension etc.? If you have a pacemaker, why did you need one, where was it placed, how long ago? Have you had surgeries or cardiac interventions? Where, why, when? What medicines are you on? If you take a blood
thinner, why? These are of vital importance to doctors and can help them in making medical decisions and improve your treatment. If you can’t remember the names of your medicines or dates of procedure, write them down on a piece of paper and carry it with you on your wallet or purse.
You need to know as much about yourself as possible.
4). Have your own advocate to look after you. It may be impossible in some medical situations to be in control of your healthcare. You may be under the influence of medications, sedated or unconscious. This is why you should consider and have a relative or friend be with you to help you especially if you go to an emergency room, during the admitting process or when medical decisions need to be made. If at all possible call and contact the patients family doctor. Notify him/her of the patients hospitalization and current problem.
5). Take notes and ASK questions. During unexpected medical situations, people don’t always have the luxury of being able to think things out. It is normal to be overwhelmed and in a state of disbelief or shock. Most doctors are still conscientious and caring and will not mind or care if you ask questions. However, try to avoid being confrontational, pushy or demanding. I love teaching and explaining. But there is nothing worse than a family member or friend who have an attitude, a chip on their shoulder, who are curt and come across abusive. Some start a dialogue by informing you that everything is being written down to be reviewed by their lawyer. No body like this type of encounter and is only normal for any doctor or healthcare worker to close up, become defensive and turn a bad situation worse. Now is not the time for intimidation and scare tactics.
Remain courteous, try to stay calm and together everyone will everyone will work towards the same goal of providing the best possible care for the patient.
.