Wednesday, July 28, 2004

hospital stuff

this trackback is in love and honor of michelle.

i've managed to stay pretty healthy for the most part, and so has my wife. but i've learned some things about hospitals, both working in them as a contractor and being a patient at them.

1) it has been my observation that communication in hospitals is frequently piss-poor at best.

i was once working as an emergency medical courier. i got a call to go to an airport and pick up some donated organs that were being flown in from somewhere. my instructions were to take both organs (packed in sealed boxes, i obviously didn't directly handle the organs), a liver and kidney, to a major hospital in downtown big city. the boxes were to go to the transplant immunology department. i was to let the lab person there remove what he wanted from the boxes, and take what he did not want to another hospital.

tech takes blood and node samples from box for final type test and crossmatch. he says i am to take both boxes. i get in car and proceed to drive to second hospital.

emergency call comes from my supervisor: turn around and take the liver back to the previous hospital, the patient is on the table waiting on you. this one isn't my fault, it's the lab guy's fault. still, it begs the question: a patient is in the or, without a liver (an organ that can not be mechanically replaced like a heart or kidney). why didn't the tech know what body parts to grab when i arrived?

better yet -- it turns out i'd been given the liver in error. why wasn't this communicated to me, that i was only supposed to get the kidney?

so i drop the liver at the or nurse's station, and I'm off to the other hospital with the kidney. when i get to the lab at the second hospital, the lab tech says, "oh, he's got a kidney!"

the. woman. did. not. know. that. a. kidney. was. coming.

and the second.

when my wife was in the hospital with our twins, in labor at 33 weeks, it became painfully apparent that the two doctors responsible for her care (one day and one night) were obviously not communicating, and as a result we got confused about what our treatment plan was.

here's what i've learned:

0) while it's supposed to be the doctor's and nurse's responsibility to look out for the best interests of the sick patient, and to respond timely to the patient's questions, they frequently don't.

1) the patient must be his or her own advocate. if the patient isn't capable of doing this because of illness, the next of kin or local friend must do it. passivity will not get you good care. politeness might help, but firmness is essential.

2) ask questions. ask questions repeatedly if you don't understand or the staff isn't following through with their promises. if you reach the point where you think you're being an asshole, don't apologize: there's a reason it's happening, and that reason isn't because you're stupid or a bitch.

3) every hospital has a list of patients' rights and responsibilities. take it seriously. if your care providers do not, wave it in their faces. you have the right to have your pain taken seriously; you have the right to a second opinion from a qualified doctor at your request; you have the right to understand the risks and benefits of your treatment; you have the right to know the qualifications of the people treating you, including the nursing staff.

4) adult heart rates are in the 50-90 range normally. fetal heart rates are much faster. ask what the rate they're getting is. if it's in the adult range, one of two things is happening: your nurse is listening to the wrong heart, or your baby is in life-threatening distress and you need immediate intervention.

5) "what kind of doctor are you?" or "what specialty was your residence in?" is a perfectly valid question to ask any doctor. if you want a particular kind of doctor, you have the right to ask the doctor you get if he's the kind you want.

6) lying to a patient can frequently get you fired. professional staff should never do it; in many jurisdictions, doctors and nurses can be disciplined or lose their licenses over it.

7) visiting hours are a good idea, to let patients get what rest they can. however, no hospital should ever throw out the father of a pregnant woman's baby, and any hospital that tries deserves a complaint filed by the patient with the state regulatory agency. it is reasonable for the hospital to require that husbands whose wives' are in a semi-private room not disturb the other patient. it may be reasonable to ask the husband to sleep in the waiting room, especially if he snores. however, inviting him to leave the hospital is a definate no-no. that would never happen in an obstetrics unit; it should never happen in any other unit, either.

8) every hospital has an "ombusman" who is responsible for receiving and dealing with patient and patient care complaints, and acts as an independent adovcate for the patient, if necessary even against the hospital staff. you got notice of who this is and how to contact them in your admit paperwork.

9) any hospital must discharge you ama upon request unless they get a court order to hold you, and doing that is complicated, expensive, cumbersome, and must be done quickly.

a) holding you in the hospital only for medicare/medicaid paperwork in the absence of medical necessity may constitute a number of crimes, including insurance fraud, kidnapping, or false imprisonment.

b) you, as your own medical advocate, have the right to get your questions answered. you have the right to have your questions answered about your medical condition, about your care-givers qualifications, licenses, and accreditation, and about financial arragenements surrounding your care. if you or your advocate don't get answers, you have the right to insist upon them. while some of us might feel like being insistant is tantamount to being rude, the truth is that sticking up for yourself in the face of incompetence or laziness or lack of understanding is neither rude nor wrong. if the professional staff can't handle your politely worded (if extremely pointed) queries, the problem is theirs.

c) threats about lawyers are effective. they're usually not good as a first tactic, but after two or three fuckups they can be quite effective. my favorite tactic in that department is to call the nurses station and ask for "a yellow pages so i can find an attorney."

the way michelle got treated at the hospital she went to was atrocious. and while it's really the hospital's responsibility, unfortunately as often as not the hospital staff dumps the burden on the patient.

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