When Doctor and Nurse Are Not Enough: Patient Advocate to Protect

If it's medically related, it will likely go wrong in a hospital. The statistics on misdiagnosis, wrong medications, mistreatment and people dying in a hospital is harrowing. In the USA it's escalated to the degree that this year, 2008, the errors that Medicare no longer covers includes bedsores.

What can you do about minimizing these incidents for you or a loved one?

Many if not most hospitals now have someone on staff with the title Patient Advocate or sometimes Patient Relations. Get to know this person as soon as either you or your loved one is checked into a hospital.

Ask to meet or at the very least, telephone talk with someone on staff about who is the Patient Advocate in their hospital, what your loved one is in the facility for and let them know that you may well call on them during the stay for their intercession on your behalf.

How to Know When to Get Acquainted

My experience with advocating includes three hospital stays for my husband, open heart bypass surgeries and a heart attack. The first time I knew nothing about this and put up with poor communication and lack of understanding on how to make the stay more comfortable for him. Fortunately having friends who were nurses be at my side was helpful. Do you have a friend or family member who can be with you during your love ones hospital stay? This is the lowest level of support you want to consider.

The second time my husband was in a hospital, a long time best friend who also experienced her dad's hospital illness, told me more than I thought I would ever need to know about patient advocacy. It all came in handy the second and third time around with my husband. Actually, it wasn't all I needed to know.

The third time with my husband, the previous learnings let me lead the way; more on that as you read key points below.

Have you heard that cliche "the third time is a charm?" Well, it is true.

Then, anticipating cataract surgery, a week in the planning and on the schedule, was to clear my mom for this process so she could see more clearly. Other plans were about to unfold. My mom, at 80 years old, had open heart aerotal valve replacement surgery.

Another truth is every life experience is a lesson learned.

When do you want to get acquainted with your role as a patient advocate? Now. Immediately, before you are thrown into it.

When do you want to get acquainted with the hospital's patient advocate staff? Immediately upon your loved ones admission.

It's likely that at some point in all of our lives, especially baby boomers like myself, are going to see someone we love in a hospital or nursing home. You want to be forewarned and prepared because your loved one's life is at stake.

Start with these basics:

• How attentive are the nurses? Do you hear your loved one complaining about how long it takes for the nurses to ask the call bell? Does your love one complain about an ailment going unnoticed?
• Do either you or the patient know the on duty nurses name? Often times hospitals have boards on a wall in the room in clear view for the patient to see the name of that days nurse. If not, you want to ask.
• Ask for the name and extension of the attending nursing supervisor. Just as doctors and nurses change with shifts, so do the nursing supervisor. You want at least the extension to this person in the event you cannot reach the Patient Advocate.
• Carry a small notepad with you. Note date, time, doctor and nurse attending and the incident. My mom was given Oxycontin and had a most adverse affect. Upon readmission just 10 days later this was not transferred to the new attending staff who wanted once again to give her this narcotic drug as a pain medication. Because of the written not of these things, more attentive listening from a nursing supervisor got results: an newly written item in the patient record and a discussion of what medication would be best.
• At the point you may not be getting results, you can call for a consultation with all medical professionals. This is a high level request so exhaust the discussion line of going to the nurse, physician's assistant, physician and then the patient advocate.

How to Ask So You Get Speedy and Acceptable Results

Two examples and then a quick summary of how to ask for the help you want:

My husband's open heart redo, his second one in 10 years, opened my eyes to the world of how you must ask for what you want to be different or you will get the same dismal attention. He came home with bedsores on his foot heals! As a diabetic this can have lethal repercussions. When he had to be readmitted just two months later, the two page later I wrote had already circulated to three important people: the director of nursing, the chief operations officer or senior staff in charge of payment and the marketing director.

I telephoned ahead to the director of nursing on the third visit to give her a heads up that my husband was in an ambulette to visit again and this time I wanted his admission and stay to be more positive.

She was waiting for us, talking with attending nurses, when I arrived to the room.

Key points:

1. Since you don't know when you or your loved one will be readmitted, always write a letter to several hospital leaders to update them on what you liked and did not like about the care during the stay. Do this within 30 to 60 days after the care stay.
2. Give a key contact, maybe someone who responded to your letter because you will hear from someone, prewarning should you or your loved one need readmission.

On a Monday readmission, my mother brought to my attention that her left arm was swollen and the nurse had not seen this. We called in the nurse who dismissed it saying "Oh that's not that bad," as she left the room. I followed her just outside the door and used my own arm for her to understand how normally my mom's arm is even smaller than my own. "You can either have me call patient relations," I said assertively, "or you can call for the physician or physician assitant, but this is not anything to dismiss."

The physician assistant was at my mother's side within the hour.

Key points:

1. Never take, "that's nothing," as an answer from any medical staff for anything with you or your loved one.
2. Ask more questions.
3. Ask for either a physician or physician assistant if your nurse doesn't either have an answer in interest in helping further.
4. Suggest, assertively, that you call the Patient Advocate if you find you are waiting to long for answers or resolution.

Open heart surgery patients receive a heart pillow to help them cope with sneezing, coughing and even laughing for ensuing weeks after surgery. My husband would have a collection of several by now but why keep these reminders?

My mother wasn't even all that excited about it until between the intensive care unit and the stepdown, someone on staff lost it. She was in the stepdown for four days and still the nurses promise to, "get another one," was not followed up.

The morning of mom's discharge I called to thank the Patient Advocate for her intervention on two specific incidents. In closing I asked for one more small favor: could she replace the lost heart pillow before my mom leaves?

In rehabilitation facility now as I write this, my mom is getting signatures on this pillow from aides, nurses and doctors who she likes and wants to remember.

No request is too small to ask of the Patient Advocate on staff.

One to one findings with most nurses is that they have genuine compassion for their patients and love of their work. A few, well, they appear like they are just in it for the money.

The truth is: nurses are overworked.

They can work 12 hour shifts for four or five days in a row.

One nurse might have 12 patients to care for in what seems like one day. In reality if have of those patients get transferred or discharged, then in 24 hours the nurse is caring for 18 patients!

While the surgeon is the one to fix the clogged arteries or the narrowed aeortal valve, it's the nurse who mends the patient.

I'm not a nurse or in anyway have a profession in the medical field. We do need nurses; I know that much.

This real life experience is in three different hospitals in the USA. While many internet resources have something to sell you, do not be detered to gain all the information you can on being a Patient Advocate, whether for you or someone you love.

This is your life or a loved one's life at stake!

Noteworthy internet findings:

Patient Advocate Foundation; a non-profit that helps with finding finances and even health insurance help.

Patients Are Powerful; also non-profit and claimed to be, "physicians, nurses, office managers, HMO administrators, legal advisors and advocates currently working in today's managed care environment."

This is not meant to offer ideas of getting medical reimbursement, legal advice or specific home health related issues. It is meant to inform you that most hospitals have a patient advocate who can help you if you know what you want.