The Informed Patient: A Complete Guide to a Hospital Stay
248
The Informed Patient: A Complete Guide to a Hospital Stay
248Paperback
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Overview
Karen A. Friedman, MD, and Sara L. Merwin, MPH, offer hands-on advice about how patients, health care providers, and medical staff can work together to achieve good outcomes. Through anecdotes, tips, sidebars, and clinical scenario vignettes, The Informed Patient presents ways to enhance and optimize a hospital stay, from practical advice on obtaining the best care to dealing with the emotional experience of being in the hospital.
Product Details
| ISBN-13: | 9781501709951 |
|---|---|
| Publisher: | Cornell University Press |
| Publication date: | 11/15/2017 |
| Series: | The Culture and Politics of Health Care Work |
| Pages: | 248 |
| Product dimensions: | 6.00(w) x 8.90(h) x 0.60(d) |
| Age Range: | 18 Years |
About the Author
Read an Excerpt
CHAPTER 1
Why You Need This Book and How to Use This Book
Why do you need this book? Honestly, it's because everyone ends up in a hospital sooner or later and very few of us have the knowledge, skills, and confidence to ensure the best possible care.
We have written this book in response to our observation that most individuals do not come into the hospital well prepared with either advocacy skills or an advocate to help them navigate an inpatient stay during this emotional time. Health care has become ever more complex with increased technology in the age of information. Health care providers are busier than ever before and are also inundated with changing technology, rapidly advancing treatments, and a heightened paperwork burden. As a consequence, more vigilance by the patient is required to remain safe.
SOME STATISTICS
Here are a few figures about hospital stays that may surprise or alarm you:
• There are 34.4 million hospital discharges per year in the United States alone, not even including the Veterans Health Administration system.
• The average length of stay for hospital visits is 4.8 days.
• Between 210,000 and 400,000 patient deaths a year may be attributed to preventable medical errors in U.S. hospitals.
• Ninety-nine thousand patients die as a result of hospital-acquired infections each year, according to the Agency for Healthcare, Research and Quality.
MEDICAL ERRORS AND BEYOND
Patient safety has become a major concern of the general public; policymakers; and local, state, and national government. Frequent news coverage has been devoted to individuals who were victims of serious medical errors. In 1999, the Institute of Medicine published a book called To Err Is Human. This was a groundbreaking report because it exposed just how dangerous a hospital stay can be. It opened our eyes to the real risks of a hospital stay, asserting that ninety-nine thousand patients die every year from preventable medical errors, an estimate that has risen dramatically since 1999. When we talk about medical errors, we mean two different kinds. The first is an error of commission — a fancy way of saying that something specifically incorrect was done or given to a patient. An error of omission, on the other hand, means that the patient did not get the medication or procedure or provision of care necessary, or that something varied from what the medical profession calls the standard of care.
In its 2003 follow-up report, Patient Safety: Achieving a New Standard of Care, the Institute of Medicine emphasized the importance of standardizing and better managing information on patient safety to reduce the risk of harm and ensure good care.
A study in the journal Health Affairs showed that one-third of hospital patients have adverse events (unwanted and potential problems resulting from medical care), and approximately 7 percent are harmed permanently or die as a result. This study brought new attention to the safety issues that were originally brought to the forefront by the two Institute of Medicine books. Unfortunately, even though hospitals are making headway in the arena of patient safety, it is still unsafe to be hospitalized and will continue to be so.
WHY YOU NEED TO BE AN ADVOCATE OR HAVE AN ADVOCATE
Medicine as it is practiced now is so complex and time is so limited to health care providers that certain aspects of care in the hospital can be overlooked or mistaken. We want to make sure that things go as smoothly as possible by helping you become well informed and encouraging you to speak up when you have concerns.
Advocating for yourself or your loved ones in the hospital is not easy. Even if hospitals were perfectly run, immaculately clean, and staffed uniformly with kind and generous human beings, it would still be daunting and bewildering to be an inpatient. And this is because when we are ill or fear for our loved ones, we are emotionally vulnerable. This is true even for those of us who work in health care.
It is vitally important to be assertive (NOT aggressive). So many of us have learned to be unnecessarily deferential to doctors; this is particularly true of the older generation, whose members would not think of questioning the doctor. Times have changed. It is a mistake to blindly accept treatment or submit to tests recommended by your health providers; it is perfectly reasonable to ask questions and to be a participant in your own care. In fact, "shared decision making" is a concept that has been embraced by the medical community, and it relies on patients to be actively involved in their health care and to make decisions in concert with their health care providers. Increasingly, there is an emphasis on patient preferences and values to help medical professionals make the right choices suited to the specific needs of the individuals they care for.
The cornerstone of this book is that you, the patient, can become an active participant in your own health care story. Recently and fortunately, the medical field has moved away from a paternalistic approach that put physicians at the top of the hierarchy and you, the patient, at the bottom; you were expected to follow directions without questioning the doctor's reasons and rationale. When it comes to choosing between treatment options, it is important for you to express your own wishes.
We want you to have the best possible outcome from a hospital stay; all patients have the right to insist that the health care providers and hospital staff do the very best by them.
WHAT YOU WILL LEARN
We are going to give you a great deal of information about what happens in the hospital: how modern hospitals are organized, the roles and descriptions of the various professionals and other hospital staff taking care of you, what tests you might encounter, common medications, how you can get help when you need it, and what you can expect during your stay.
HERE IS HOW YOU CAN USE THIS BOOK TO BEST ADVANTAGE
Think of this book as a necessary training manual. If you have a planned surgery or have elderly or ill family members, you will certainly have to deal with a hospital visit. Given the complex nature of hospital care, you will need to educate yourself in order to be prepared. This book is intended to be a valuable resource to help you navigate the turbulent waters of hospital issues and problems. Managing the hospital experience for yourself or your loved one is your new job. Now you will begin training so that you will be prepared and ultimately successful.
You can pick and choose topics according to your need. You do not have to read this book in the order in which it is written or in its entirety. You can start anywhere, depending on what your specific need is. What you will find is a kind of reference book, filled with details and information. However, there are certain ideas and principles that we feel are so intrinsic to your success as an advocate that we have highlighted them as tips and stressed them for emphasis.
Tips
We have emphasized and repeated certain elements that may seem obvious but that in the setting of caring for yourself or a hospitalized loved one you may forget. You will see these tips interspersed throughout the text. They are to remind you about your role in helping yourself or your family member.
Sidebars
When we want to delve a little more deeply into a topic, we present sidebars. Usually this is a more detailed explanation of something discussed in the section adjacent to the sidebar. Or it might be an insight about hospital workings not typically known to the general public.
Vignettes
Of course it is not possible to describe all the conceivable situations patients and their families will experience during an inpatient stay. We have chosen some typical types of scenarios to paint a picture of the universal questions and qualms that you might have. When appropriate, at the end of the clinical vignette, we propose a solution to a commonly encountered problem.
ABOUT TERMINOLOGY
The "Patient" and the "Doctor"
Throughout this book you will see us refer to "the patient," as "yourself," "your family member," or "your loved one." That person could be you, a spouse, a child, a parent or other relative, a friend, or a neighbor. In certain instances, a patient will be able to advocate on his or her own. More often than not, because of fear, pain, or confusion, patients find themselves at a loss to assert themselves when hospitalized. For convenience, we will use the terms "you," "your patient," "the patient," and even "your loved one" to mean the person for whom something needs to be done.
Likewise, we will alternate between using the terms "doctor," "physician," "health care team," and "health care provider" to mean the licensed individuals who are responsible for your care. Some of them may be medical doctors (MDs), doctors of osteopathy (DOs), nurse practitioners (NPs), nurses (RNs), or physician assistants (PAs). When we refer to "health care professionals," we include social workers, respiratory therapists, and physical therapists in addition to the providers mentioned above.
Vocabulary and Terms
In the medical world, some words that we are familiar with in everyday life take on a particular meaning. You will hear certain words over and over again: assess, evaluate, manage, follow, indication, attending. It may be difficult to make sense of what you are hearing, particularly at first. Further, there is a medical lexicon unto itself filled with Latin and scientific words, and it will be impossible to understand all the medical talk around you. We have italicized many terms, explained their meaning inside the world of the hospital, and put them in a glossary at the end of the book for easy reference.
CHAPTER 2
The Changing Landscape of Medicine
Almost everything about how medicine is practiced in the United States and the developed world has changed over the past twenty years: there has been a proliferation of new tests, new technology, new medications, and new specialties. Thanks to these improvements, along with better nutrition and preventive care, the population is living longer. Along with this extension in life expectancy come more medical problems. It is impossible for doctors, much less laypersons, to keep up with all these changes. More difficult still, in the new paradigm the patient is the consumer. To be an uninformed consumer when it comes to health care puts you at a distinct disadvantage.
We are all bombarded with print, TV, radio, and Internet advertisements for medications, doctors' practices, medical technologies, specialized procedures, and even specific hospitals. Everyone is selling wares in the medical marketplace. And everyone wants your business. Health care is very, very big business. It didn't use to be this way. Your doctor knew what medications you needed and you followed his (emphasis intentional) advice. You didn't question, and you didn't think about other options or choices. You didn't have to "prepare" for a doctor's visit or trip to the hospital by reading up. You didn't have to research which medications would be best for you. In short, you were not a partner in your health care, nor were you an informed consumer. But much has changed, and nowhere are the changes more evident than in the hospital. Most patients are diagnosed by laboratory results and imaging techniques. Physical diagnosis is a dying art. Decisions about patient care may be made in a room far away from the patient instead of at the bedside.
MORE CHANGES: HOSPITALISTS VERSUS GPS AND FAMILY DOCTORS WHO COME TO THE HOSPITAL
Among the biggest changes in medicine is that more and more often, there are doctors who work ONLY in the hospital and do not see patients on the outside. These doctors are called hospitalists. This movement has mostly been in general internal medicine (practitioners we used to call GPs, general practitioners, or family doctors), but it has been so successful that now there are pediatric and neurology hospitalists, as well as hospitalists managing (taking care of) medical issues for surgical patients. This is a trend that is here to stay. It has proven to be efficient and been demonstrated to improve care, although it may seem more than a little impersonal to patients and their families.
What this means is that the doctor, generalist or specialist, you see for office visits may not be seeing you in the hospital at all, or if so, less frequently. Even if a hospitalist does not take care of you, the likelihood is that if you see a doctor in a large group, the junior physician of the group, even if he or she is not your own doctor, will be looking in on you in the hospital.
RAPPORT AND COMFORT VERSUS EFFICIENCY AND QUALITY CARE
Although the reliance on hospitalists may seem impersonal to you, it does allow your primary care provider (PCP) or general practitioner to give you more attention when you are seen in the office. In addition, it turns out that there really is quite a difference between the doctoring skills needed in the hospital and those needed in the office or clinic. There is now so much to learn in medicine that this new kind of specialization makes very good sense and ultimately saves you money by keeping health care costs down. While some internists can successfully manage both arenas, many struggle to find the right balance.
You may find it somewhat off-putting to be cared for by a complete stranger rather than your own primary care provider, someone with whom you have had a relationship for years. However, the doctors who work exclusively in the hospital are really well equipped with knowledge and training to take the best possible care of you. On an interpersonal level this may be of little comfort to you when you or your family member is ill.
The new system has proved to be better for patients and doctors alike, and you can remain confident that patient safety and well-being are enhanced by allowing certain doctors to focus all their attention on taking care of hospitalized patients.
OTHER PRIMARY CARE PROVIDERS
There has been a large growth in a new kind of health care provider to help relieve the tremendous pressure on physicians to evaluate and treat patients. Since the mid-1960s and the passage of Medicare and Medicaid legislation, there has been a chronic shortage of primary care physicians in the US health care system. Other health care providers have picked up some of the load. Nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) all have had specialized training to take care of patients in partnership with (and sometimes instead of) physicians. In most states, according to regulations, NPs and PAs are licensed to write prescriptions in the same manner as doctors.
Although there are many critics of these terms, nurse practitioners and physician assistants are sometimes referred to as midlevel providers or physician extenders. We present these terms for completeness, since you might hear them in your hospital stay, but we will not be using them in the remainder of the book. Nurse practitioners and physician assistants have been termed midlevels because their training is less than that of doctors and the level of health care they are licensed to administer is different from that of RNs. They have a minimum of a bachelor's degree, and most have also completed graduate or master's-level education.
HIPAA
By this point most people have run into the HIPAA privacy law, which was put into effect in 1996. HIPAA stands for the Health Insurance Portability and Accountability Act and was signed into law by then president Bill Clinton. HIPAA was designed to protect personal medical information from getting into the wrong hands. Although this law creates extra paperwork and sometimes acts as a barrier that prevents families from obtaining information in the hospital, it does protect patients' privacy. Particularly in this age of electronic information, there is a need to be extra careful about a person's individual data or information. In fact, what HIPAA does is protect the security and privacy of your medical data. So the HIPAA forms are beneficial to you, and you should not hesitate to sign them.
(Continues…)
Excerpted from "The Informed Patient"
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Copyright © 2017 Cornell University.
Excerpted by permission of Cornell University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
PrefaceAcknowledgments1. Why You Need This Book and How to Use This Book2. The Changing Landscape of Medicine3. The Emergency Department Experience4. Getting Settled and Finding Your Way5. Figuring Out the Care Team6. Physicians of All Kinds7. Lines, Ports, Drains, Tubes, and Catheters8. Tests and Procedures in the Hospital9. Nutrition in the Hospital10. Protocols and Precautions11. Intensive Care Units (ICUs)12. Special Patient Populations13. Elective Surgery14. Unplanned Surgery15. Discharge16. Some Final ThoughtsGlossaryindexWhat People are Saying About This
Patients who use this book to guide them through their hospital stay will be well rewarded. These days hospitals want to partner with patients and want them to be informed. Karen A. Friedman, MD, and Sara L. Merwin, MPH, have written a useful reference book where patients can look up what tests they are about to have and what procedures they are having. The fact that this book walks a patient through their stay and explains why things can take so long is also a strength.
In this immensely useful and readable volume, Karen A. Friedman, MD, and Sara L. Merwin, MPH, demystify the hospital experience and provide patients and families the information they need to navigate the confusing swirl of a hospital stay. Bring this book with you to the hospital—it will make your stay more understandable, it will keep you more engaged, and it might just save your life.
Dr. Friedman and Ms. Merwin have created a purposive walk through the hospitalization process, from ER all to discharge instructions. The writing is accessible and a must-read for anyone facing hospitalization, and real-life examples make the text that much more meaningful. Well-organized chapters and a thorough glossary and index help the reader find focused information, while educating the layperson on medical terminology—a necessity in this day and age where patients must often advocate for themselves and family members. The book is a delight from start to finish.
The Informed Patient is a comprehensive encyclopedia used to assure the safe landing of patients and caregivers as they navigate through the complexities of health care encounters. A must for all consumers of the health care industry.
The Informed Patient is a must-read for anyone ever hospitalized, going to be hospitalized, or caring for a friend or family member who is, was, or will be hospitalized. The reader will be given the skills and confidence to approach a hospitalization in an informed manner, demystifying the experience.