THE HOSPITAL CHECKLIST

by Rajeev Kurapati

Hospitalization can be a harrowing experience. Patients arrive seriously ill or injured, and in addition to whatever ailments they’re suffering, they must simultaneously find ways to cope with unfamiliar medical professionals and uncomfortable procedures. We doctors and hospital support staff are often asking these people—some of whom might be quite sick or in a great deal of pain—not only to quickly understand their complex conditions and treatments, but also to arrange for the assistance and care they’ll need after discharge. Many will find themselves facing new medications, follow-up treatments, a rash of specialists, unfamiliar equipment, and physical limitations—and this barely takes the emotional strain into account. It’s not difficult to see why such a large number of patients and their families report being overwhelmed by a hospital stay.

As a hospital physician, I see patients and families every day who struggle to understand the information they are (or sometimes aren’t) given. Patient advocacy—for yourself or for someone whose care you’re responsible for—significantly affects health and recovery. I want to help make you better at it.According to the World Health Organization, a study in eight hospitals showed that the implementation of checklists during surgical procedures reduced the rate of deaths and surgical complications by more than a third.

It seems likely, then, that patients would benefit from a checklist of their own. The following list is a resource meant to aid patients and their loved ones in better preparing for and understanding what information they’ll need before, during, and after a hospital stay.

hospitalchecklist

 

1. After admission, ask the names of your primary hospital doctor and the other specialists who make up your physician team. Your primary hospital physician will coordinate with the team, and your nurses will assist you during your stay.

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2. Ask your physician: What is my main diagnosis, and are there any other newly diagnosed issues? Feel free to express your fears and anxieties about your diagnosis to the physicians and nursing staff. Don’t let the anxiety build until it becomes uncontrollable.

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3. Ask your nurse or physician: How are my illnesses responding to treatment? Ask the nursing staff in particular about how your condition is progressing and how you can facilitate your recovery. It’s your fundamental right to obtain information regarding your medical condition. Understanding both your diagnosis and your treatment plan is a central tenet of the Patient’s Bill of Rights, which was adopted by the Association of American Physicians and Surgeons in 1995. According to this document, all patients are entitled “to be informed about their medical condition, the risks and benefits of treatment, and appropriate alternatives.”

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4. Ask your family, friends, or other trusted individuals to be involved and help support you in your recovery. Yes, it’s hard to put ourselves in a situation where we feel like we’re burdening someone or losing our independence, even for a little while. Understand that these people are an integral part of your treatment team and contribute to the success of your recovery.

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5. Ask to speak with a hospital social worker if you have questions about insurance and billing related to your stay. The social worker is there to help clarify what your insurance covers and how much you may be required to pay. If you need assistance with payment, discuss the options available to you with the social worker before you leave as well.

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6. Ask to see the nurse manager or charge nurse if you’re experiencing ongoing issues with care or communication about your condition. The person in this role is responsible for helping patients and easing any misunderstanding or tensions that may arise during your stay.

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7. As you approach discharge, ask if you should continue taking any of the medications (including vitamins and supplements) you took before you were admitted. This information should be included in your discharge instructions, but take the time to fully understand this aspect of your care to avoid potentially disastrous or even fatal complications later.

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8. Ask the staff to show you and your caregivers how to perform any tasks prescribed for after you’ve left the hospital, especially any treatments that may require a special skill, such as changing a bandage or giving an injection. Ask the nurse or physician to remain in your room while you practice to ensure you’re doing it correctly.

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9. Ask your nurse or physician if it’s safe to perform ordinary tasks alone, like bathing, dressing, driving, or exercising. Make sure you’ve arranged for help with any of these activities before you leave the hospital.  

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10. Ask your nurse or physician if you can or should use any medical equipment, such as a walker, brace, or health monitor, to help with your recovery and comfort. If the answer is yes, ask for assistance in obtaining these items before you leave or shortly after your return home.

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11. At the time of your discharge, ask the discharge nurse any questions you have about your discharge information. You should have been provided with printed discharge instructions. Don’t leave the hospital without obtaining these, reading them (or having them read to you), and making sure you understanding allof the information they cover.  

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12. Ask about any follow-up appointments or additional testing. Take a moment now to record anything that’s already been scheduled or to schedule necessary appointments in the coming weeks.

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My hope is that regular use of this checklist will aid physicians in providing more streamlined and accessible care; will further educate patients in how to advocate for themselves; will help facilitate the best possible hospital experience for patients; and will reduce or eliminate some of the strain on the emotions, wallets, time, and energy of everyone involved. If we can ease the many demands of a hospital stay, we’re working in service a medical team’s goal: a successful patient recovery.


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Saints and Doctors: What’s the Connection?

by Rajeev Kurapati

To approve sainthood to a pope, the Vatican only needs one miracle. And there we have it, a new saint.

Pope John Paul was named a saint by Francis after a Costa Rican woman is said to have been cured from a brain aneurysm after praying to John Paul in 2011. His first miracle, curing a French nun of Parkinson’s disease, was also confirmed.

What makes a religious or sacred act holy is evidence of a miracle. We all need evidence – and there is, indeed, evidence.

To institutionalize a belief, a procedure must be followed, just as in any other organized entity. When declaring someone a saint, the Vatican is required to certify that a “miracle” was performed through the intercession of the candidate – a medically inexplicable cure that is lasting, immediate and directly linked to prayers offered by the faithful. The process is comparable to a peer-review procedure – one pope endorses another to promote him to sainthood.

The anointing of sainthood appears to be merely another step in the hierarchy of the church – similar to the rankings of priest, deacon, and pope. The rather mechanical process evokes a much deeper inquiry not about the basics of sainthood, but the purpose behind it. We can’t help but wonder: Do miracles happen?

Here’s a tale from my every-day life:

Part of my job as an attending physician at a hospital is to run codes. At this particular time as the doctor on duty, we had a 73-year-old male patient who was deteriorating quickly – his breath labored and his pulse gone. He coded several times and was revived with shocks. About 45 minutes into the whole exercise, we deemed the attempt futile. Although the patient had a faint pulse, his blood pressure was not detectable. Most other vital parameters were rock bottom; oxygen saturation levels were too bad. Everything about his situation rendered a sustainable recovery impossible,.. or so we thought.

The next morning, a member of the nursing staff was shocked to hear the patient, who had nearly been declared deceased just hours earlier, utter the words “I’m hungry, as if he woke from his deep slumber.

I’d call that a miracle.  

I don’t know if there was any “guiding hand” involved in the process, or it was just a mere coincidence that modern medicine fails to explain.

A miracle is something that seems logically impossible.

Our human intellect can’t fathom such an occurrence as possible. In these cases, we tend to attribute bad events to fate and “miracles” to divine intervention.

Should we dismiss both the good and the bad “unexplainables” as merely random? More over: What makes a few cells of a 5-year-old turn against themselves to become cancerous – ultimately robbing a child of the chance to experience what life on Earth has to offer? And, if these cells can turn against themselves to become cancerous, can they become buddies again, morphing back into healthy cells? It’s possible, but also worth asking: Is it possible that faith plays a role in these kinds of “miracles”?

Miracles defy the natural order – brain aneurysms aren’t supposed to “go away” and Parkinson’s isn’t supposed to be cured. But, what do we call it when the natural order takes a turn for the worse – when a healthy father’s heart stops beating with a sudden phone call that is daughter has been kidnapped and killed. We don’t call this a miracle. We call it a disaster.

Intense anguish, like grief felt after the death of a loved one, can cause a seemingly healthy heart to come to a complete standstill. Grief can evoke the same symptoms as a heart attack – chest pains, trouble breathing. It’s estimated that about 2% of heart attacks in the US are actually caused by “broken heart syndrome.” A body in seemingly health physical condition suffers this heart ache not by way of a blocked blood vessel, but proved by a surge in stress hormone like adrenaline that overwhelms the heart making it temporarily weak.

If such intense stress can break you, why can’t intense hope heal you?

To some, this hope comes in the form of faith. What cures the faithful is not merely a strong conviction in an ideal, but the intense hope triggered by belief.

It’s almost true. Sometimes it’s your faith that activates “miracles.” Miracles break the laws of nature as we know them – hiding behind the curtains of our perceptions. We’re oblivious to our role in miracles, so when they occur, we call it chance.

For a lot of us, our convictions in a higher being or lack thereof, serve as the vantage point to which we view the world around us. Anything that occurs outside of the bounds of our perception is looked at with suspicion or cynicism. We make the observational error of assuming that only what we understand is legitimate and that anything beyond our comprehension is merely a sham.

You don’t need glorious labels such as that of a saint or guru to not only wish, but evoke goodness onto the world. A life without mystery is not worth living – it is that which occurs outside of our comfort zone that makes life exciting.

People with faith in an underlying force have more room for the mysteries of life than those who refuse to believe in anything transcendent. Belief and hope has the power to liberate us from the cynicism of our minds and to open up our hearts to the possibility of miracles.

The Doctor exhibited 1891. Sir Luke Fildes 1843-1927. Presented by Sir Henry Tate 1894

The Doctor exhibited 1891. Sir Luke Fildes 1843-1927. Presented by Sir Henry Tate 1894

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Is Your Doctor “Good”?

by Rajeev Kurapati

Being a patient is never something that anyone (not even doctors)  likes to experience. The word patient is derived from the Latin word, “suffer.” All patients walk into the doctor’s office expecting their doctor to bring them out of their suffering.

What makes a doctor, good? Here are a few traits essential to all doctors:

Compassion

Compassion is not a virtue that comes packaged with medical training. It’s an innate trait that can be nurtured by emulating caring mentors in medical schools. Some people are innately more compassionate and caring than others. If you are lucky enough to find a caring and compassionate doc, you are in good hands for he/she is sure to take great lengths to get you through your ailment. Studies have found that these values are strongly linked to higher quality of care and better patient outcomes.

Competency

Competency includes knowledge and skills to perform the job effectively. Competency comes only from training and experience. For doctors, experience begins with training and starts the moment they enter medical school. Competent doctors are able to interpret the situation in the context that is relevant, especially during emergencies. Staying up to date on the latest research and technology is essential to becoming a great doctor.

Bedside Manners

Numerous studies have shown a link between lousy bedside manners and poor medical outcomes. Every patient wants to find a doctor who listens. A doctor can be among the best in his field, but if he/she has poor bedside manners, patients are forced to choose between competency and kindness. Young doctors in training can learn good bedside manner by emulating compassionate physicians.

Action Plan

Clarity of thought process and action plan is important in assessing a clinical condition. If your doctor orders a test, he/she must also know how to deal with the results. Having an action plan means that your doctor has control over the situation, whether treating a medical condition or consulting a sub-specialist when he/she is not sure of the treatment options.

Being a good doctor means embodying all the above characteristics. The next time you make a doctor’s visit, evaluate your doctor against this criteria. Is your doctor “good”?

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