Patients need an advocate at the bedside

Being a hospitalized patient is perhaps one of the most disempowering experiences an individual can face (besides being in war, or a prisoner). Patients face constant uncertainty; having no idea what time their physician will visit, when they will be taken for their tests, or who will suddenly interrupt them again with a demand – perhaps an early morning blood draw, or yet another round of interrogation and uncomfortable examination (by students, trainees, and consultants).

One would imagine that hospitals would feel like safe havens with good-hearted nurses, physicians, and other health care professionals nurturing patients and ensuring their every need is met. One would imagine that, however — despite marketing claims by hospitals — the reality is a lot more complicated. Despite million-dollar lobby makeovers and smiling faces of hospital staff on billboards, patients don’t feel like enough attention is paid.

In many instances patients are correct. The simple truth is that there is a pervasive “profits over patients” ethos in modern medicine that contributes to suboptimal patient care regardless of institution. Health care professionals constantly find themselves overworked and understaffed, and their employers seem to get away with this because despite health care being a heavily regulated industry, there is no oversight of the moment-to-moment management of patients.

After taking a certain number of steps to mitigate medical errors, here is what I recommend to all hospitalized patients: Try to have a patient advocate at your bedside as often as possible. It can be your partner, a family member, or a close friend. After working across a dozen hospitals — I’ve noticed that patients who have someone with them seem to get better care than vulnerable patients who are alone. The reasons for this based on my observations are as follows:

1. Patients sometimes forget to address their concerns. As a patient you may not only be ill; but also sleep-deprived, irritable, and perhaps even a little bit confused due to medication effects. Unless you’re constantly scribbling down questions and then dutifully pulling out a sheet of paper to present to your health care team — you’re bound to forget to ask all your questions. The questions I suggest every patient ask daily are these:  i) What are the alternatives to what you’re recommending?; ii) What is the diagnostic and treatment plan for today?; and, iii) What is my discharge plan, and can I complete this treatment at rehab or at home?

2. Patient advocates may provide valuable information. I’ve lost track of the number of occasions that family members have been able to provide invaluable collateral information. Often pharmacies are closed in the middle of the night and primary care offices unreachable – but an organized family member can save the day with an accurate medication list and medical history. On other occasions, loved ones have pointed out medication allergies, subtle changes in mental status or the neurological exam that the team didn’t notice, and sometimes have even prevented medical errors outright.

3. Having a trusted ally at the bedside forces more engagement from the health care team. Typically as a hospitalist, I am in charge of 16 to 20 patients. If each patient takes me on average 25 to 35 minutes to examine, review diagnostic tests, and update the family — then essentially that means my last patient is seen about 7 to 11 hours after the first. Many days I don’t have time to cycle back and see earlier patients again because there are inevitable emergencies, new admissions, and discharges to take care of. If however, a family member arrives with concerns, I take the time to go back and discuss matters with them and the patient. Of course, I also go back if called by a nurse or patient themselves if there is ever a need to reevaluate the patient, but engaged families provide another opportunity to connect the dots that are so often missed in patient care.

Varun Verma is an internal medicine physician and CEO, Medofi. He blogs at his self-titled site, Varun Verma, M.D., and can be reached on Twitter @VarunVermaMD

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