July 28, 2010
A Guide to Your Next Hospitalization
No matter what the circumstances for hospitalization — from something as eagerly anticipated as childbirth to something as scary as a serious illness — it can be distressing for patients and their families. Here are some ideas to help prepare for what can be a trying and chaotic time.
Know Your Doctor; Have a Doctor
It is not just because I am a primary care physician (PCP) that I believe that everyone needs one. There needs to be someone you can identify as the person in charge of your general health, the one point-person who is keeping track of what is going on with you from coordination of routine preventive health care to life-threatening situations.
Having a PCP who knows you before your next hospitalization can make a big difference. First, it means that the person caring for you in the hospital isn’t a stranger. Second, it means that the person trying to diagnose what’s wrong has a general sense of what you’re like normally. The emergency room physician may not know if you usually slur your Rs, giggle hysterically or walk with a limp, but your own PCP will.
Once you find a PCP with whom you are comfortable, find out whether she takes care of her patients when they are hospitalized. An increasing number of PCPs limit their practice to the office and have a doctor who specializes in hospital medicine (a hospitalist) care for the inpatients. There are clear advantages to this model — it is more efficient with the physician’s time, and it allows greater expertise in a more focused field. But there are also disadvantages to this model — the biggest being that you should expect the doctor who knows you best to care for you when you are sickest.
Know Your Medicines
If you take multiple prescription medications, the names and doses of those medications will be one of the most important pieces of information for the emergency room physicians caring for you. Always carry an updated list of your medications (as well as over-the-counter medicines and supplements), including dose and frequency. The list will make your nurse’s job a lot easier and will immediately alert the emergency physician to your medical problems. It can also help prevent you from receiving medications that could interact with medicines you are already taking.
Know Your Hospital
Find out to which hospital your doctor has admission privileges. For some patients, an affiliation with a well-reputed hospital is an important criterion for choosing a PCP. Is the hospital a teaching institution? Some patients prefer the world-class specialists and excellent reputation of academic institutions; others prefer to avoid the loss of privacy and the large care teams that can result when trainee physicians are involved. If possible, try to be hospitalized where your own doctor can care for you. Obviously, in an unexpected life-threatening emergency, all this planning is discarded. Just call 911 and try to make the best of it.
Have an Advocate
Your thinking and decision-making are compromised when you’re sick, scared or in pain. You can’t remember the important information you received from the physician caring for you. You can’t figure out what questions you should ask. That’s why it’s important to have someone whom you trust and who knows you well at your side. That doesn’t mean your loved one has to be with you 24/7 during your hospitalization, but he or she should be there when doctors are telling you test results, discussing your plan and making important decisions about your care. This should be the one person you would trust to make decisions on your behalf. Doctors and ethicists call this person your surrogate decision maker. It’s important that your doctor know who that person is. There are various legal documents for identifying your surrogate decision maker, but far more important than the document is just telling your doctor, “If I’m ever too sick to make decisions for myself, I want my brother Joe to make decisions for me.”
Know When to Say When
The ugly truth is that not all diseases are treatable, not every injury heals, and none of us has unlimited time. Modern medicine is good at saving lives, but our ability to restore functionality and quality of life is lagging. This all too frequently results in months of invasive treatments that prolong life long after the patient can no longer enjoy its benefits. Some patients want everything possible done to prolong their lives regardless of its quality, and their wishes should be honored. But other patients at some point say “enough” and refuse further life-saving care, opting instead for measures that provide comfort. If you haven’t thought about the circumstances under which you would not want further care, you are not avoiding those circumstances; you are simply shifting the burden to your family to make gut-wrenching decisions when those circumstances arrive. Choosing not to think about this does not make it less likely to happen. Unfortunately, many doctors are uncomfortable broaching this issue, so take the initiative.
Know When to Go Home
Hospitals can be dangerous places that expose patients to risks. Occasional medication errors, highly resistant bacteria and frequent sleep disruption make the hospital a place you should want to leave as soon as possible. If you can walk, care for yourself and take oral medications, and if you don’t have an immediately life-threatening problem, you should probably be at home. Unfortunately, insurance companies and hospital administrators are so eager to discharge patients promptly that patients often reflexively dig in their heels and believe that it’s in their interests to stay as long as possible. Don’t make that mistake.
Your discharge from the hospital is packed with critical information. Before you go home, make sure you understand which medications you should be taking after discharge (and update your medication list), what warning symptoms to look out for and when you should follow up with your doctor.
Hospitals are great places for healing but are terrible places for the healthy. I only hang out at hospitals because it’s my job. Get well, and get out.