A guest post by Karen Friedman MD and Sara Merwin MPH, authors of The Informed Patient: A Complete Guide to a Hospital Stay (Cornell University Press).
Linda was having a busy day: 9 to 5 at the office, and now grocery shopping. But she wasn’t feeling right. She was a little warm and dizzy and felt heart palpitations. She finished shopping and hurried home because she knew something was wrong. But what had her doctor told her? Chew an aspirin if she ever had heart attack symptoms.* Call 911. Linda wasn’t taking any chances: too many people depended on her. She called a friend to meet her in Emergency, grabbed her pill bottles and her printed medical history, and stuck them in her purse.
Linda is savvy. She had symptoms that could have been confused with any number of things, but she made a series of wise decisions: she followed her doctor’s advice, called a friend to help out, and went to the hospital armed with her important records.
At the hospital Emergency Department (ED) she meets a triage nurse, who is trained to determine the seriousness of patients’ medical conditions and their need for immediate care. Linda is only 49 years old, but has been diagnosed with heart disease. The triage nurse examines Linda and alerts the emergency medicine physicians that there is a patient who might be having a myocardial infarction (heart attack). Linda is whisked into a cubicle where doctors and nurses ask her questions. Her friend records the names and professions of the hospital personnel and the types of tests that Linda will have.
Although the ED seems chaotic, every person working there has a role. Linda has made the jobs of the Emergency physicians and nurses easier by providing her medical history and the names of the medications she’s been taking. This is important since certain medications will affect treatment decisions. Having an advocate by her side is invaluable for her own comfort, safety, and vigilance.
Speak up
Fortunately, the triage nurse recognized that Linda might be having a heart attack. However, as we know, heart disease in women is often under-recognized. If you have shortness of breath, chest pain, or any of the other worrisome symptoms listed below (or if you have been experiencing any of these unusual symptoms in the days leading up to today’s hospital visit) bring these symptoms to the attention of the nurses and doctors immediately.
The tests begin…
Linda is hooked up to a 12-lead EKG to record her heart rhythm. She’ll have a series of blood tests to see if her cardiac enzymes are high, meaning there is a blockage of the vessels that bring blood to the heart muscle. The emergency medicine doctors have called in a cardiologist who has decided that Linda will be admitted for more testing, including a cardiac catheterization.*
Specialized care for heart patients
Patients with heart conditions may be admitted to specialized cardiac units in the hospital. If you need highly specialized care and your local hospital can’t provide it, you may be transferred to another hospital that can. Patients requiring heart monitoring may be placed on telemetry where trained technicians can keep track of heart rhythms on screens.
Communication is key!
During a hospital stay, patients may be cared for by different kinds of doctors. Don’t assume they’ve all spoken with each other. Ask your healthcare providers what the other specialists have said. If there are hospitalists – physicians who only take care of patients in hospital – they’ll coordinate communication and your treatment.
Back to our admitted patient…
Linda is transferred to the cardiac catheterization lab. There she meets an interventional cardiologist who performs the angiography to visualize the coronary arteries and place stents to “unblock” them.* After the procedure, Linda is transferred to a regular hospital room. Her husband and teenaged children are on their way and bringing Grandma and Grandpa. Everyone has been worried sick!
Practicalities:
Nutrition: Sometimes, things get mixed up in the complicated world of the hospital and the wrong food tray is brought to you. If your tray doesn’t look right, let your nurse and the dietary staff know.
NPO (nothing by mouth): Before a procedure or surgery or while the care team is investigating the source of a problem, you might not be allowed to eat or drink except for a sip of water to take essential medications.
Roommates: After your procedure, you may be sharing a hospital room with one or more other patients. Be respectful of your roommates, their families and visitors. Occasionally there is an unfortunate mismatch of roommates. If the problem cannot be solved, have a conversation with your nurse to see if you can be moved.
Visitors: Many patients get great benefit from the attention and care of visiting friends and family members. Besides the comfort visitors bring, they may be advocates and helpers when staff is busy with other patients. The decision about which and how many visitors is highly personal. It’s not your job to entertain visitors. Encourage friends and family who understand your needs, and discourage those who might not be in tune with you, or who may cause stress.
Helpful Tips:
Before you go to the hospital:
Whether you’re going to the hospital for a planned procedure or find yourself in an emergency situation, prepare ahead to help make it a better and safer experience.
- Create a medical history list with current and past conditions, surgeries, and names and telephone numbers of your doctors and closest family or friends to call in case of emergency. Print all of this out or store it in your phone.
- Prepare a current medication list with drug names and doses.
- Bring a family member or friend to watch over and advocate for you.
- Write everything down! No one can remember and process medical information when they’re feeling weak or frightened.
If you’re admitted:
- Ask all hospital providers and staff to identify themselves and their role in your care.
- Find out which doctor is in charge of your care. If you have a complicated medical situation or there is difficulty making a diagnosis, there may be many consultants. However, there will be one doctor who has overall responsibility.
- Decisions about tests, procedures, and treatments should be made together with your doctor, with you as an active participant. Ask if there is a less invasive/painful/expensive way to receive treatment or testing. This includes surgery!
- Medical errors happen. Try to be watchful and not let your guard down. Many medical mistakes happen through infections. It is always appropriate for you to ask if the person touching you or your medical equipment has washed their hands.
- Knowledge is power! The more you understand what’s involved in your care, the better you can advocate to make a safer and better experience.
♥
June 17, 2018 – www.myheartsisters.org
*Chewing a full-strength aspirin (with water if you like) at the first sign of heart attack symptoms is common medical advice unless you are allergic, or if your doctor has advised against aspirin because you are already taking blood-thinning meds like Coumadin.
*Need a translation of any cardiology terms here? Check out my jargon-free, patient-friendly glossary of complex terms and names!
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Dr. Karen Friedman, Vice Chair for Education, Residency Program Director, and Associate Professor of Medicine in the Department of Medicine at the Hofstra Northwell School of Medicine in Hempstead, NY, and her co-author Sara Merwin, Director of Clinical Research and Assistant Professor of Research in the Department of Orthopaedic Surgery at Montefiore Medical Center/Albert Einstein College of Medicine in New York City. Their book is called The Informed Patient: A Complete Guide to a Hospital Stay.
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Q: What do you wish you had known before your own hospital admission?
See also:
Post-hospital syndrome, revisited
Study: “91% discharged from hospital without care plan”
What I wish I’d known before my hospital discharge
Does your hospital have a Women’s Heart Clinic yet? If not, why not?
A doctor’s perspective: 10 worst hospital design features
What if hospital staff could read our minds?
Informed consent: more than just a patient’s signature
Kindness in health care: missing in action?
♥
NOTE FROM CAROLYN: I wrote about what heart patients can expect before, during and after a hospital stay in A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press)
Heart Sisters 
Great tips for the hospital stay! This is a comprehensive post, and I can’t think of anything else people can do. Speaking up is crucial, no matter what the circumstance.
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Hi Beth – thanks for weighing in here. Speaking up IS crucial, absolutely. Ironically, that’s often the problem though. The person charged with speaking up, monitoring what’s happening (or not), asking questions, being on alert, etc is the person lying in the bed, feeling ill or scared or overwhelmed. The important thing to remember seems to be what NOT to do (lie there passively assuming that all is well, or being afraid to speak up).
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The issue of medical mistakes when it comes to prescribed pharmaceuticals is an ongoing battle. I ask every time, and mistakes are still made. Once the cranky respiratory therapist held up the foil packet with her hand covering the name on the packet and said see, it’s what was ordered. It wasn’t, and I was coded. Now, I’m to the point where I take a plastic Zip-loc bag for each day I’m an inpatient and put all of the pill packaging for the day into the baggie.
I’ve had hospital pharmacists come to my room and tell me that my allergy, while life threatening to me, is unusual and cannot be flagged in their machines, dispensers, computers, etc, so the error will probably happen again. I need to be aware.
It begs the question if my life is endangered by being in the hospital, why should I stay?
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Good grief. Yet another argument for not making assumptions about anything that happens to you while hospitalized (like the hospital pharmacist isn’t going to send over something that you’re deathly allergic to). I like your zip-lock bag idea, Tommieo – that and my trusty steno pad (the ones with the coil spine, for taking notes of all kind) will live on the bedside tray….
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I have to take quite a lot of supplements and prescription medications. EVERY SINGLE TIME I’ve been admitted to a hospital I’ve had a current printed list with me, including doses, times I take them, and total amounts.
And EVERY SINGLE TIME, even when I’ve had an extra copy to actually give the pharmacist representative, it’s been screwed up, sometimes with potentially dangerous results.
If the patient isn’t mentally, physically, or emotionally up to the task of checking and double-checking, she really needs to have an advocate who can do that for her – someone willing to speak up, insist on looking at what’s put into the hospital’s computer, and to make sure meds are delivered on time and in the right amounts.
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Hello Holly – thanks for raising an important point to remember when offered helpful tips that will only work if you’re dealing with hospital staff who actually DO SOMETHING with those carefully prepared lists. You are an experienced and model patient when it comes to helping hospital staff take better care of you.
I love the idea of having an advocate alongside when you’re a hospital patient, but to expect that your advocate must double-check everything that’s being put into the hospital computer about you seems like it’s simply shifting the responsibility away from those whose paid job it is to care about the accuracy of such things.
I sat at a very ill friend’s hospital bedside for 5 1/2 weeks a few years ago (and did all of those things you mentioned – and much more!) and even though I was careful to use my most pleasant PR voice and manner as her advocate, I can confirm that hospital staff can get pretty cranky about being repeatedly asked about what they’re doing and why.
I still believe that carrying a list of all meds is a good idea, particularly for those who have no clue what the ‘white pill’ or the ‘pink pill’ is for.
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It certainly is the paid hospital staff member’s job and duty to enter the meds information completely and accurately. But in my experience, even when the staffer is very well-intentioned, it just doesn’t happen. There were always mistakes, some quite minor (which I never bothered mentioning), others potentially life-threatening. And if the patient or her advocate doesn’t check, and watch for the meds to actually be delivered in a timely manner, how will anyone know a mistake has been made?
Of course, if the patient isn’t taking anything that matters for her well-being over the course of a day or two, it may not be a big deal for her. For those of us on meds that are necessary to sustain life it’s a different story. My point in writing is *someone* must check to ensure the meds list is put in accurately, and *someone* must also ensure the patient receives those meds, in the correct doses, and on the correct schedule. If she can’t advocate for herself, then she needs someone else willing and able to check these things – politely, but firmly. Her life is worth the risk that a staffer might get cranky – but if polite questions asked when *needed* cause crankiness, maybe the caregiver needs to be changed.
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I agree 100%, Holly! But I’m dismayed because patients and their advocates now MUST be the *someone* who needs to ensure that staff are indeed doing what they should be doing. In this guest post, the authors make it seem so simple: just bring your list of meds with you to the hospital and that’s it! But as you so clearly describe, it’s too often not as simple as that at all…
And as for replacing cranky hospital staff – that’s a bigger issue, largely dealing with the many reasons they are cranky in the first place!
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The challenges many hospital workers must deal with can be very stressful, and lead to inappropriate crankiness with patients and visitors, unfortunately. Better pay, better (more) staffing, and recognition for kind, professional work would all help. I did my small mite in thanking and complementing the staff I dealt with who were considerate, caring, and competent, but I don’t know how to pay them enough for the challenging jobs they have!
Interestingly, the hospital at which I had the worst experiences (and to which I will, if conscious, refuse to go to ever again) had no patient feedback questionnaire. The hospitals I would gladly go to if I needed care all had questionnaires of one sort or another (online and mail-in). If a patient’s health suggests a hospital stay might be in her future, she might like to research the hospitals available to her and choose based on patient feedback.
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Wow, you know your hospital is no longer even pretending to be interested in improving when they can no longer be bothered to distribute patient feedback forms.
Excellent points about thanking and complementing hospital staff when we notice their skills, kindness or anything that helps to make the patient experience more bearable. That’s basic courtesy. Won’t put more staff on the ward, or money in their pockets, but it may help to inject a moment of humanity and kindness…
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