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Archive for the 'Surgery' Category

An Open Letter to Hospitals

Please note that this column appeared in the Syracuse Post Standard on September 13, 2011.  It addresses the recently issued New York State Hospital Report Card.  You don’t need to be a resident of Central New York, or even New York State to gain benefit from this column.  Resources for you are found below.

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Dear Central New York Hospitals:

It’s report card time.  That time when we patients get the opportunity to learn whether or not you’ve improved your patient care and outcomes since last year.

I was hoping to find glowing reports. After all, you know exactly what will be measured and what needs to be done to earn the highest grades.  No one’s expecting miracles; just safe and timely care, a clean environment, pain management and effective communications.

But did I find stellar reports?  No.

Granted, the report card says I have less of a chance of catching pneumonia at St. Joes.  And, Community General, congratulations on your infection rate which is lower than the average hospital in New York State.  Both St. Elizabeth’s and Faxton in Utica are doing quite well avoiding Pulmonary Embolisms and Deep Vein Thromboses.

But those are only three high grades among almost four dozen measurements.  My real concerns are for those that registered lower than statewide averages – so low that some patients are dying, acquiring infections, suffering pain, and leaving your facility in worse condition than when they were admitted.  Each one of you earned the lowest possible score in at least three categories.

According to news reports, one official blamed bad scores on outdated statistics. Sorry – that’s no excuse! Your patients are human beings, not statistics.  Perhaps their pain, debilitation or death took place a few years ago, but many of those patients are still in pain, still debilitated and yes, still dead today.

As you know, beginning next year, Medicare will take patient satisfaction survey scores into account when it comes to determining reimbursements. We patients don’t require much to score you highly on those surveys.  We expect only the basics: communicate with us respectfully, prevent infections, avoid mistakes, keep us as pain-free as possible, and send us home with instructions we understand and can carry out.

Put another way:  treat us the way you would treat your own loved ones. Provide for us what you would provide for them.

Such an approach is bound to land you in the top tier on next year’s report card.

Best regards,
Trisha Torrey
Every Patient’s Advocate

PS:  Patients can find New York State hospital report cards by linking to http://www.myhealthfinder.com/newyork11/. Pay particular attention to patient safety and satisfaction measures. Then use those scores to choose where you want to be hospitalized. Your life may depend on it.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

More Hospital Report Cards (more states)

How to Choose the Best Hospital for You

A Patient’s Guide to Hospital Infections

How to Prevent Hospital Infections

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About.com Patient Empowerment

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Informed Consent Requires Clarity – Do You Have It?

(as published in the Syracuse Post Standard August 16, 2011)

Recently I was chosen to participate in a new writing project. There were some basic details and responsibilities I was expected to agree to, including a specific number of articles, average number of words, and some other typical expectations.

I was given a contract to sign. After a careful reading, there were some strange differences from others I had signed in the past. I found some hedge words in the contract which could mean I would do all the work, but they could decide not to pay me, yet still have the rights to use my work. Red flags!

I didn’t jump to conclusions. Instead I asked questions. “Will you explain what this means?” “Will you give me an example of how this might work?” Eventually we clarified the fuzzy wording, worked out the terms, and I signed the contract.

But – and this is important – I didn’t sign it without making a few alterations to the descriptions. Each party initialed those changes, then signed the contracts.

So why should you, my reader, care about my writing contract?

Because every time you need certain medical tests, any medical procedure and many treatments, you are asked to sign a contract, too. It’s called “Informed Consent.” By law, those services cannot be performed unless your signature is obtained ahead of time on an Informed Consent document. That consent provides legal protection to both you and the person who performs the service.

The real question before you sign is, have you been thoroughly informed? Do you understand the risks, benefits and alternatives to whatever service is about to be performed? Do you know exactly who will perform it? Have they managed your expectations?

Sometimes Informed Consent documents will have hedge words or statements in them, like my contract did. For example, “to be performed by Dr. Serg Ury or his representatives” may mean your surgery will be performed by someone you don’t expect. Just who are his representatives? They might be his partners, or they might be students. If it is important to you, then clarify, and change the wording if necessary.

Wise patients never sign an Informed Consent document until they are very clear on what is about to happen, who will be making it happen, and what the risks, benefits and alternatives are.

Clarity will provide confidence that you understand what is about to happen, and that you’ve made the right choices for you.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

Understand Informed Consent

Trauma from Violations of Informed Consent

Patients’ Rights in the United States

How to Prevent Surgery Mistakes on the Day of Surgery

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Want More Patient Empowerment?
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About.com Patient Empowerment

…and…
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Patient Empowerment Tips

Uh-oh Video! (Can’t escape it…)

When it comes to TV and video, Al Roker provides one of my favorite quotations:

“They say the camera adds 10 pounds. OK. So I figure I must be standing in front of 10 cameras.”

Oh, yes, Al. I know how you feel….

However — I’ve decided to come out of my video-avoidance closet to share the following with you all.

First — my excitement at the invitation a week ago to appear on MSNBC to speak to a problem that I actually cited a few years ago – that July is the worst month of the year to be hospitalized. Why? Watch and see!

Visit msnbc.com for breaking news, world news, and news about the economy

(Even got my two cents in about hiring patient advocates!)

So that’s the first one.  But if I’m going to jump in to the world of video, I might as well do it with both feet.  Many of you know that I am brought in to speak at various conferences and meetings across the US and Canada.  I enjoy speaking!  So in my attempts to do even more of it, I’m told I need to have a professional video made.  So, yes, I finally bit that bullet, too, and have uploaded the online version of the opening here.

It’s not like I’ve never done TV before – I have done local TV on a number of occasions.  And broadcast isn’t the problem – ferheavensake, I have hosted a radio show for 4+ years!  But video, in general, has just always been a step I’ve avoided.

Until today.  So, OK, I feel better now.  [[gulp]]

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Hospital Gets a Plus, Communication a Minus

It’s been awhile since I posted — but you’ll understand why.

My father suffered a mild heart attack a few days ago, and (thanks for asking) is doing as well as can be expected. In his 80+ years, he has never had any indication he had a problem with his heart!  A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be….

In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just make an appointment to see my primary….”) emergency personnel arrived and whisked him off to Sarasota Memorial Hospital (Florida) where he spent the better part of the next three days.

smhospital1Some rigorous testing, a heart catheterization and an angioplasty of a small artery later, Dad is home and getting his sea legs back.

I happened to be visiting him when it struck – amazing timing, don’t you think?  I’ll be here for a few more days to make sure he’s on his feet and feeling more confident, as we review what led him to a heart attack and what adjustments he’ll need to make from here.

Of course, little did those who helped Dad know that a critique would be forthcoming once we were past the initial shock and care. I’ve been making observations throughout that might help all of us get the care we need.

I can’t say enough GOOD about Sarasota Memorial Hospital.  I’ve been admitted to, and visited, many hospitals, but by far, SMH is the best I’ve experienced.  Here’s why I say that:

The personnel were very helpful. No one was ever too busy to answer a question or explain what we needed to know.  When we had questions about the meaning of the various numbers appearing on the monitor he was attached to, each section was patiently explained to us.  When they moved Dad to a room, I was able to get easy directions to find him. When Dad was admitted, he mentioned he hadn’t eaten any breakfast or lunch, and a turkey sandwich appeared.

The hospital is immaculately clean, from the facilities to the people.  A great deal of emphasis is placed on washing and sanitizing hands and surfaces.  I watched the cleaning people use great care in cleaning up behind the patient in the next bed, wiping off every surface including the phone, the bed controls, the TV remote.  The personnel that actually touch patients (nurses, others) were diligent about washing their hands and sanitizing.  The only time either Dad or I asked them to wash their hands was in the emergency room, and then the nurse told us she had sanitized before she came in the room (although I didn’t see any dispensers outside the room.)  But she was happy to comply when Dad asked. Of course, the entire point is to avoid infections.

Dad’s nurses, in particular a young man named Eyves who was available the entire day of his procedure, and the night nurse, Bren, were particularly helpful.  Dad had a rough time of it — a lot of pain and nausea.  Both were right there for him and did everything they could to keep him comfortable.

The check-out process was excellent.  All instructions were explained to us carefully. Dad, foggy from so much painkiller, had some trouble processing instructions, but the discharge nurse was very patient, taking it very slowly so it could sink in.

Even the food in the restaurant is good!  Add that to the free parking, great signage (very easy to find my way around) and the fact that we could use cell phones, had free internet access and no restricted visiting hours…

The ONLY fly in the hospital ointment was communication from the doctors — a problem that was a much larger minus than it needed to be.  The problem was this:  we were told that both the proceduralist who performed the heart cath/angioplasty and another doctor would visit us a few hours afterwards to explain the findings and next steps.  It never happened. In fact, the proceduralist NEVER visited, and Dad’s new “assigned” cardiologist (the recommendation from his primary) didn’t visit until the next day.  Both he and the primary get a few points for phoning me (it was 7:30 AM, and I hadn’t gone in to the hospital yet).

This problem was not about the actual communications; rather, it was about managing our expectations.  If we had been told we wouldn’t be contacted by either doctor until the next morning, we would not have expected it, nor would I have been upset when we didn’t.

And this is where Dad’s nurse, Eyves, gets more brownie points. When I made it clear how peeved I was many hours after we expected the proceduralist to arrive, he tracked down another doctor in that same practice who then called me and explained in a very detailed manner exactly what the findings were during Dad’s procedure.

This won’t be our last experience with Sarasota Memorial Hospital. My parents are both older and both have health issues. I expect I’ll get to know much more about this facility. I’m very thankful to know there is so much emphasis on the important aspects of care.

One more point to make:  as mentioned, Dad was “assigned” his new cardiologist.  I helped him understand that he is under no obligation to accept that assignment.

The same is always true for you.  Referrals can work out well, or they may not.  Just because you are referred to a specific doctor does not mean you are obligated to stay with that doctor.  You may always choose your own doctor, as may Dad.

No one ever wants to be hospitalized, but if you’re in Sarasota and you need hospital care, give Sarasota Memorial Hospital a try.

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Informed Consent Called Into Question

A new post by my blog guest Anonymous, poses a question, “Informed consent is just a cruel joke, isn’t it?”

This gentleman, who underwent surgery, was given Versed as anesthesia, despite stating that he did not want to be given any drug that would render him unconscious.  So, not only did he deny consent, he stated that he did not want to be put to sleep at all.

We don’t know too many of the details, and we have not been given the other side of this story.

But it does call patients rights into question.  And our understanding of Informed Consent.

Take a read — see what you think — and if you have ideas for what could have been done differently?  Please post your comments, too.

Versed, PTSD and Questions About Informed Consent

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