I have many friends who are doctors and nurses, and we all moan among ourselves about the state of health care and how we hope we are never the patient. We know hospitals are chaotic, the staff is stressed, and electronic health records are only making patient care harder.
I read a blog post by another doctor, Val Jones, MD, who agreed. She blames the problem on “frequent turnover,” or the large number of mostly uncoordinated care providers weakly connected by glitchy computer systems.
If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to a person with no short term memory. It’s as if the hospital itself has some kind of dementia.
Because of the incredible degree of turnover inherent in today’s inpatient care systems, patients are examined “from scratch” by every new shift of nurse, physician, physical therapist, case manager, etc. There is very little context available to assist with interpreting how the patient is doing compared to their previous state. Searching for such pearls can be time consuming in a medical chart that is not designed for clear communication, but billing purposes.
This lack of organization in the hospital, the frequent “handovers” from one care provider to another, is a primary cause of medical mistakes—too many tests, lost test results, delayed care and incorrect diagnoses.
A personal story
Several years ago my husband was hospitalized overnight following what should have been a short-stay surgical procedure. (He had a bad reaction to a pre-op med that he should not have been given, but that is a story for another post.)
While in hospital custody, lying dispiritedly in the bed of his semi-private room, he could not help but overhear the multiple conversations taking place behind the thin curtain that separated him from his roommate.
This roommate, he gathered, was elderly, mentally slow, and suffered from multiple health problems. Many specialists came into the room to speak with the patient, who was alone. Each doctor asked questions specific to their specialties, but many were the same. The patient, confused, answered the questions differently every time.
Each doctor attempted to carefully explain to the patient what he or she thought was wrong and what needed to be done.
After several hours of listening to these mostly one-way conversations, and realizing each doctor was getting conflicting information and they were all coming to different conclusions, my husband could no longer stay silent. He stopped one of the doctors on the way out of the room and relayed his observation that because the patient had been giving different answers to the same sets of questions, the doctors might not have a very accurate picture of what was happening.
Shortly thereafter, the patient was taken from the room, for diagnostic tests he supposed, and my husband never knew what happened to him.
This story highlights the reality of what is happening in hospitals now—there is no ring leader in the circus. The clowns and monkeys are out of control. It used to be the responsibility of the primary care doctor to call in a specialist to consult, and the specialist(s) would communicate with the PCP. Now one specialist will call in another specialist, and so on. Each makes his or her own plan of action, often without consulting with each other. Tests get duplicated or—worse—missed.
And, as Dr. Jones pointed out in her post, the same questions get asked over and over again and incorrect diagnoses get made.
Be informed and prepared
I’ve written about patient safety before and the necessity to be your own health care quarterback, or if you aren’t able, appointing a friend or family member to be there for you.
For more information, check out my previous posts on some great resources:
Consumer Reports’ Hospital Ratings: Consumer Reports published an excellent report on hospital safety, which includes hospital safety ratings as well as advice on how to stay safe during your hospitalization.
“What You Don’t Know Can Kill You”: It’s a frightening title, but written by a physician this book gives an eye-opening look at how and why medical mistakes happen, especially in the hospital. She recommends having a “sentinel,” a family member or friend who stays with you in the hospital to act as your care coordinator.
“When Doctors Don’t Listen”: This book, written by two emergency room physicians, addresses the problem of poor doctor-patient communication—which often leads to medical errors—and what you can do to improve your interactions with doctors and other health care providers.
12 tips to stay safe in the hospital: Lena Wen, MD, one of the authors of the above-mentioned book, also offers these patient safety tips that include don’t go to the hospital alone, prepare, keep records and ask about everything.
Campaign Zero: This website offers hospital safety checklists for a variety of preventable injuries such as falls, blood clots and infections. They also offer for sale a manual entitled Safe & Sound in the Hospital: Must-Have Checklists and Tools for Your Loved One’s Care.
The common theme in these resources is that you must be prepared to take charge of your own care and safety. You (or your “sentinel”) must know the who, what, why, where and when of everyone you see and everything that is done. It is no small task to take on this coordinating role, but because hospital staffing can be disorganized and electronic health records are still so glitchy, it is in your best interest to be informed and prepared for the challenge.
Certainly the poor man in the bed next to my husband could have benefited from having a caring, competent adult at his bedside, overseeing his care.