Who’s in Charge of Your Health Care?

by Jan Simpson  Who’s in charge of your health care? No one, according to Atul Gawande, M.D., who spoke at Harvard Medical School’s 2011 commencement. “Medicine’s complexity has exceeded our individual capabilities as doctors. It’s like no one is in charge, because no one is.” According to Dr. Gawande, as our knowledge about the human body has exploded (there are  more than 13,000 diagnoses, 6,000 prescription drugs, and 4,000 surgical procedures), patient care has suffered.

Consider the following statistics:

  • Two million patients pick up infections in hospitals in the U.S., mostly because of poor antiseptic precautions;
  • 40 percent of patients with coronary disease and 60 percent of patients with asthma receive incomplete or inappropriate care;
  • One-half of medical complications is avoidable.

These are frightening statistics, especially coming from Dr. Gawande, a gifted surgeon, author, and advocate for change in the way physicians practice medicine. According to Dr. Gawande, the source of this trouble is that physicians are trained and encouraged to work independently rather than in coordinated teams. He suggested that these newly graduating physicians cultivate the ability to work with colleagues like pit crews, rather than cowboys, for patients. Dr. Gawande’s full speech may be accessed here.

Forgive my cynicism for I love Dr. Gawande, the Justin Bieber of medicine. His words are always thought provoking as he challenges all within the health care system to improve patient care. Yet, I suspect that these young Harvard-trained physicians, sitting on mountains of student debt, likely envision futures as specialists or surgeons like Gawande himself, not working more anonymously as part of a “pit crew.” “Cowboys and Pit Crews” may sell magazines, but it will take time to change the way physicians deliver care.  Meanwhile, what’s a family with an ill parent or older loved one to do?

Intuitively, most of us know that the best way to care for our older loved ones is to have a relationship with one physician and minimize the time spent in the system, especially time spent in hospitals, where patients are vulnerable to infection, medical errors, or worse. Family physician and geriatrician, Dennis McCullough, M.D., who has practiced medicine for thirty years cautions, “Most geriatric doctors I know would not want their own parent in a hospital without a family member in attendance at all times.”

As a practical matter, sitting round the clock with a parent in the hospital isn’t possible. But, having spent a decade in the system with my own parents, I would like to share ten tips that can help you get the best possible care for your loved ones.

1.) Create a one-page medical fact sheet that includes a list of prescriptions, allergies, and contact information for next of kin. Leave a copy at the nurses’ station.

2.) Tell the nurses and the physicians which family member to contact with medical information. Assign one or two family members to be the conduit of all information, otherwise pieces of information may be lost if or when serious decisions need to be made. One of these members should be your loved one’s legal health care agent (see earlier blog post “Health Care Proxy & Five Wishes – at 18 and 81”). If your loved one hasn’t assigned an agent, ask the hospital for a form and complete it immediately.

3.) Spread family visits out throughout the day and evening. Try to have some family members visit around lunch and dinner time to ensure that your loved one is eating adequately.

4.) Unless your loved one has dietary restrictions, bring a frappe or Ensure to boost spirits and help keep him or her well-nourished. Do not assume that he or she is eating well.

5.) Keep a notebook on your loved one’s nightstand and ask family members to record information about each visit (e.g., Did Mom get her evening meds? What did Dad eat for dinner?). This is particularly important if your loved one is frail or may have memory lapses due to medication or illness.

6.) Bring a pound of coffee or a box of chocolates as a gift for the night nurses. Nothing is more appreciated by nurses than an acknowledgment of their help. Evenings are often when your loved one will be alone, and this gesture may ensure that he or she gets a bit of extra attention.

7.) If your elder is frail, post a one-page note about him or her and include a family photo from younger days. A young intern might find it interesting that the elder gentleman he or she is caring for was once a fighter pilot or a scratch golfer, and, as a result, may spend a bit more time with him.

8.) Remember that the average number of health care providers your loved one will see is nineteen, and much of the care will be uncoordinated. Do not hesitate to ask questions; reach out to the doctors in person, by telephone, or email. Be assertive but polite. Most health care providers appreciate family members who show authentic interest in helping a parent. Take notes in a medical diary so you can refer to them later.

9.) Make an appointment with the hospital social worker (in person or by telephone), even if your parent will be returning home. Ask about local caregiving resources, options for rehabilitation, etc. One of your best sources of information will be the social worker.

10.) Ask specifically about the timing for discharge and the kind of support that you will be getting. You don’t want to be surprised by an early morning call from a nurse saying your parent is being discharged and find your family unprepared to provide the home care that will be needed to support his or her recovery.

Above all, get your parent out of the hospital as soon as possible. With all respect to the many physicians, nurses, social workers and health care providers who work tirelessly to save lives and care for our loved ones, Dr. Gawande is wrong. There is someone in charge of the care of our loved ones: their family.

If you have any additional tips on how to manage hospital stays, I hope you will share them here.

©Circle of Life Partners™