I’ve been in more hospital visits lately than at any time since the pandemic. A lot has changed since Covid-19, but my experience confirms some good advice for older patients, their families, and the medical staff caring for them. Here are some thoughts for patients and staff. While they focus on hospitals, many also apply to nursing homes.
For patients: You need advocates more than ever. When you’re in the hospital, you’re not at your best. You may hear a lot of medical terms and may have to make difficult decisions without complete information. Understaffed hospitals may not be able to provide timely care. You must know what to do after you leave the hospital.
Once you spot a concern or have a question, try to write it down. Don’t rely on your memory. You may forget when the doctor will come.
Try to have people with you who are willing and able to ask questions. Having a good advocate has been a particular challenge during Covid-19-related visitor restrictions. If your advocate can’t be there in person, try reaching them via speakerphone or even Zoom.
Your advocate needs to be able to raise these concerns with hospital staff firmly and politely if you are not getting the care you need. For older adults, your best advocate may not be your spouse, who may be overwhelmed by the situation and unable to help. Another relative or friend may be a better choice. You can even hire paid advocates.
Ideally, your advocate should have a medical power of attorney if you cannot make a decision. But it’s more important than ever that someone helps you navigate the hospital maze, even if they don’t have legal authority.
For providers: Talk to your patient, even if an advocate or other person is in the room. Doctors (and sometimes nurses) often talk about patients rather than patients. Patient-centered care is more than a marketing phrase. Your patients know their bodies better than you do. listen to them. and respect them.
Even when the patient is dying, they often hear everything. Assuming they know what you’re talking about. Even if they can’t respond verbally, they can still respond. You need to pay close attention to those non-verbal cues.
It’s all about nurses.
For patients: You may see your doctor during your morning rounds. But you’re unlikely to see the document again that day. The staff member who knows you and what to expect during the day best is your bedside nurse. If something goes wrong, she is almost always able to answer medical questions and help with intervention. Respect nurses and what they do. Due to the current staffing shortage, they are very busy and sometimes overwhelmed. But good nurses take the time to understand your situation and how they can help.
For the doctor: Listen to the nurse at the bedside. they know.
For nurses: If your gut tells you something is wrong, say something. If you think the doctor made a mistake, say something. Tell your unit manager and hospital medical director if the doctor tries to bully you into speaking. You will save lives.
For patients: You may get bad news from your doctor. A difficult diagnosis. News of poor treatment or unsuccessful surgery. The human brain usually doesn’t handle bad news very well.
The doctor may have said something very different from what you thought you heard. If you don’t understand what your doctor is telling you, ask them to repeat it. If you are still unclear, please ask again.
Don’t stop there. Ask what’s next. What does this mean for your hospitalization and any post-acute care? What does this mean for your quality of life? Consider this bedside conversation just the beginning of the process of learning about your condition and any future treatment.
Your doctor may not be able to answer every question right away, and you will almost certainly have a more detailed discussion with a specialist when you go home. But this is an important time to start gathering information. And, back to tip #1, get your supporters with you if possible.
for suppliers. Please speak in plain language and avoid jargon. This is especially important when delivering bad news. I’ve noticed that doctors seem more likely to turn to medicine when the news is bad. For example, a surgeon might explicitly say “everything is fine” after the procedure went well, but if not, default to incomprehensible jargon. The most important time to allow yourself to be understood is when things are not going well.
I recently visited a friend who was dying. She asked if she was dying. When I told her yes, she relaxed visibly. Extensive research supports my experience. While many doctors still believe that patients “give up” when told they are about to die, patients often don’t do so at all. They want to understand the changes they are going through. You can help them.