(BlackDoctor.org) — As a former Nurse Care Manager for people with chronic illness, I’ve done my share of advocating while my patients were in the hospital. A large part of that work entailed teaching patients how to advocate for themselves, feel empowered within the health care system, and learn how to take charge when it was appropriate to do so.
Just recently, my wife was hospitalized for a very aggressive bacterial respiratory infection, and we were very grateful for the care and attention that she received during her 48-hour stay. Luckily, the infection was caught early enough and timely intervention prevented any serious complications.
In my wife’s case, it was not appropriate for her to make sound decisions when her blood oxygen saturation plummeted and she couldn’t think straight. But once she stabilized, she took the bull by the horns and made her needs known to the staff whenever necessary. As her husband (and private nurse!), it was then my job to sit back, observe, and chime in at opportune times, making sure that t’s were crossed, i’s were dotted, and promised care delivered.
The first thing to be learned about hospitalization is that you have a right to question everything that is done to you—or suggested to be done to you. When in the Emergency Department, we have to understand that, when under duress and slammed with patients, ED docs cast a wide net, ordering tests and procedures faster than you can say “Code Blue”. To some extent, this is prudent and conservative medicine that can save your life. On the other hand, many unnecessary tests are ordered in haste by physicians who simply need to cover their bases (and their posteriors!) in an efficient manner.
This is all well and good, but if you’re uninsured and come to the ED for care, you certainly don’t want to pay for a clinically unnecessary CT scan simply because your doctor was worried she might have overlooked something. Question the relative need for certain tests and procedures, and be on the look out for lazy ordering that is simply making up for a lack of time for a thorough exam and history.
Too Many Cooks in the Kitchen
Hospitalized patients are usually under the charge of an “attending physician” who may or may not be the patient’s primary doctor as an outpatient. This can matter a great deal to you, because once you are “handed off” from the ED to the hospital floor, a hospitalist will take over your care, orchestrating the game plan with the rest of the team, which can consist of multiple nurses, various specialized physicians, advanced practice nurses (nurse practitioners), anesthesiologists, radiologists, therapists and others. Chances are, this hospitalist has never seen you before and knows nothing about you, and he or she has dozens of other patients for whom he or she is responsible. Although they are busy people, you have a right to demand their attention and ascertain that they are treating you as an individual, not simply as just another body with a problem.
If you are a patient in what is known as a “teaching hospital”, medical students, interns and “residents” (senior medical students almost complete with their studies) may also be part of the team, and it can be confusing trying to sort out just who’s who.
Remember, if you don’t know who someone is or what they’re doing in regards to your care, ask to see their identification and have them explain their role to you clearly. If you are uncomfortable being examined or treated by a medical intern or student, you also have a right to refuse their care, although this is truly how they learn.
Ask your nurses (and your family) to help you keep notes and understand who is doing what and who is taking responsibility for each aspect of your care. With this information, your knowledge then becomes a tool for asking the right people the right questions at the right time.
You Have the Right to Refuse
At any time during your hospital stay, you have a right to question, refuse or accept any suggested test or procedure. Your body is still your temple even when you’re in the hospital, and you have a right to know what’s being done to you, why it’s important (or not), and what the consequences might be if you refuse. As I mentioned earlier, uninsured patients must be vigilant in making sure only necessary tests and procedures are ordered, but even fully insured patients don’t want tests that seem to be ordered as an afterthought. Understand the care that you’re receiving, and feel empowered to say no (it if feels safe and prudent to do so).