A Purple Heart was displayed next to his bed so I knew he was a veteran. Our only contact though was tossing bean-bags during activities at his Board & Care home where I visited my patients.
One evening an urgent phone call from his family asked if I would care for him as he was in the emergency room. The week before he had fallen and was admitted for a two day stay, but was deemed stable and discharged back to his home.
The hospital record indicated a family protest of the discharge as he was unable to ambulate with his walker. The admitting hospitalist dictated in the discharge summary “the heart rate of 40 will be evaluated by a cardiologist as an outpatient.” Now, he passed out and was returning with a heart rate of 30.
I admitted him, placed a pacemaker, and when he tried to walk realized he had undiagnosed Parkinson’s Disease. After medication was started and intense physical therapy begun, he was discharged home using his walker.
During his 8 day stay, the hospital continually pressured me to discharge him to a Skilled Nursing Facility (SNF). But this Korean War veteran was intent on going home and refused SNF care.
When wrapped in a shroud of pain, suffering, and discomfort, patients are unable to navigate the new twists and turns of hospital machinations. In the past we relied on trusted doctors to guide us on this road insuring correct diagnosis and appropriate care, but now physicians are pressured to fulfill hospital corporate needs and not patient care needs.
Unless you or a loved one is hospitalized, this unsettling takeover of medical decision-making by hospital administrators is largely unrecognized by the public. The purpose of this posting is not to point fingers, but to provide information so you can survive your hospital stay.
Psychologically, the predominate emotion faced by patients when they enter a hospital is fear. It is accompanied by questions like: “Will I die?; Will I suffer?”; What illness do I have?; Is it curable?; Will my quality of life be affected?”; and for many of our elder seniors, “Will I end up in a nursing home?”
Almost all patients experience fear, yet >95% leave the hospital…alive.
Be prepared to provide personal information: Insurance or Medicare/Medicaid card; social security number; contact person with phone number; who your doctor is; what you are allergic to; and an updated list of your medication.
You should have legal documents ready to present: Advanced Directive; Power of Attorney; DNR (Do Not Resuscitate) Status; POLST (Physician Order for Life-Sustaining Treatment); Five Wishes; and/or end-of-life wishes.
As part of the treatment, one might expect: IVs (intravenous) lines to give fluid or medication expeditiously; possible intubation (a tube in your airway to help you breathe); a catheter in your bladder or rectally; using a bedpan or bedside commode for bodily functions; being naked and at someone’s mercy (which some people might like!); sponge baths; cleaning by staff after urination or bowel movements; and feeling drugged up.
Don’t expect good food or to sleep well.
What is the most important asset to have upon hospital admission? An ADVOCATE.
Typically this is a family member, friend, or designated power of attorney who will be your eyes, ears, information center, spokesperson, and questioner should you not be medically able to understand or make decisions. Legal identification of this person should be made in advance of any potential hospitalization.
What can you or your advocate do to optimize comfort and care?:
>keep notes (like a diary) with dates, time, names of nurses, doctors, or ancillary care workers;
>know your diagnosis, and what tests are being done to evaluate the problem;
>list questions, and don’t be afraid to ask them;
>get a business card from every doctor who sees you and know their specialty;
>bring your cellphone, laptop, pad, earphones, slippers, comfort items including pillow, blankets, personal photos, teddy bear, etc.;
>keep an eye on your dentures, glasses, and hearing aids;
>make sure the “call button” is kept close by;
>if allowed, have family members bring in comfort food;
>ask your doctor about a timeframe for possible discharge.
>ask the name of every medication given to you (orally, IV, or patch) and the indication (there can be computer mistakes);
>if you are transported to a test, ask what it is for (making sure it is not for your roommate);
>be aware of a nationwide push by hospitals placing seniors inappropriately on palliative and hospice care. They save money at your expense;
>don’t take any patient surveys when in the hospital while you are under duress. It should be done only after you have been discharged;
>the hospital might threaten you saying you have to pay if you don’t leave. Remember, you have rights!;
>if you can’t go home, the primary facility they want to discharge you to are SNFs. Ask for more options.
There are very few patients who select SNF. Most want to return home where IV fluids, antibiotics, nursing, wound care, and physical therapy can now be provided. After a stroke or fracture, a local inpatient Rehab Unit might be available. Some patients go to the home of a family member or friend. Others may go to Assisted Living (apartment living with common dining area), or a Board & Care (residential homes with caregivers and private or shared rooms).
There is immense economic drive by hospitals to discharge patients even when they are still ill, as in the case of our Korean War veteran. This has specifically impacted Medicare/Medicaid patients. If your doctor is employed by the hospital or a contracted agency (eg. HMO), medical decision-making may be skewed in the hands of business administrators which serve their financial interest, but not your healthcare interest.
Everyday, admitting physicians are assailed by hospital personnel to discharge you. They use criteria (lab tests, x-ray, vital signs, etc.) gathered by computer which doesn’t always reflect patient symptoms nor the doctor physical exam. Yet, this limited flawed data is used to force discharge.
You must have an advocate, and you must be one yourself. Gathering information even when you are ill, understanding all aspects of your admission, and maintaining accountability will allow you to survive your hospital stay.
Gene Uzawa Dorio, M.D.