Hospitals are busy, hectic, and unpredictable places. Professionals who work in health care are highly trained and competent individuals, and if you are receiving acute care in America — the standard of your treatment and access to high-quality tests and an array of specialists, is unparalleled (take it from someone who has worked in different countries). Nevertheless, the hospital experience itself, despite our best efforts, often falls short. Here are things to watch out for if you, or a family member, is ever hospitalized:
1. The emergency room. These are understandably frantic places. You’ll receive a dizzying array of investigations — from blood tests to CT scans and MRIs — and eventually be hit with the unfortunate news that your condition requires admission to the hospital.
2. Transfer to the floor. A whole new team is going to receive you. Because of the rapid nature of emergency medicine, the story of exactly what brought you in, may not be entirely clear. It’s a good thing that you have to go over everything again with your new team. Your symptoms and medical history must be made entirely clear to all. Don’t take it for granted that everyone knows what’s going on.
3. Your medicines are incorrect. You, or a family member, realize on hospital day 2 that your hospital medication list is completely wrong! This could be for a number of reasons including: your latest pharmacy record was not updated in the hospital system, there is an old computer note that was used to generate your medication list, or you have recently seen another physician who changed your regimen around. The best thing to do is to have your latest list with you to go over with the doctor or nurse.
4. You are treated for your condition. This is the part that we are very good at. You may have a surgical procedure or medical treatment, and you begin your recovery.
5. Lots of different doctors. I call this Too Many Cooks in The Kitchen Syndrome. For whatever reason, a lot of different physicians are seeing you (perhaps you developed an unexpected complication). Each doctor is giving you a different opinion, and sometimes they even seem to contradict one another! It seems like your main doctor (whether a medical attending or surgeon), seems a bit confused too — and isn’t talking to the other doctors. That’s not because they are lazy or bad at what they do. It’s a system issue.
6. Not mobilizing. I call this Sinking in Bed Syndrome. You are a few days into your hospitalization, and your recovery seems slow. The less you use your muscles, the weaker they become. Doesn’t everyone know that? Your family is asking as well for you to be sat up in the chair and walked. It isn’t that hospitals don’t want you to do this simple thing; it’s just another system-wide issue with not prioritizing it enough. Either way, you need to mobilize to regain your strength, so insist on it if you feel it’s necessary.
7. The discharge process. You are finally feeling better, and your physician walks in and announces that you can leave! What follows is what’s called the “Discharge Haze,” when all the other staff from nurses to case managers, realize that they also have to quickly get all the ducks in a row before you leave. Things move rapidly, you get a whole load of unintelligible computer print-outs and a new medication list. Make sure you understand everything that needs to happen from here (don’t be embarrassed about clarifying everything down to the tiniest detail), before you find yourself out of the hospital.
8. Timely follow-up. Whether or not there have been enough studies confirming this, having an expeditious follow-up with your primary care doctor and other specialists is one of the single most important things you can do to make sure you have a complication-free return back to baseline, and prevent coming back into the hospital. Unfortunately, America’s primary care is broken (strong primary care should be the backbone of any health care system). Hopefully you have a good physician you can follow up with, and hopefully, your hospital has been in touch with them about your admission. You better double check this before you leave (it shouldn’t all be on you to communicate your medical diagnoses and treatment).
Every doctor or nurse sees the above scenarios happen every day, in every hospital, as we do our level best to provide great care to our patients. Do you notice anything about the above issues though? Most of them are not particularly costly to fix. They are simple common-sense communication and system problems. We have a health care system that is outrageously expensive (for both the country and the individual). We may not be able to magically fix the more fundamental problems, but we can at least all take steps to ensure that patients have as smooth a journey as possible when they need our help.
And if you’re a patient or a family member, expect the above to happen — and always be your own best advocate.
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