March 11th, 2009 by Trisha Torrey
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.
Some 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.
February 2nd, 2009 by Trisha Torrey
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
January 9th, 2009 by Trisha Torrey
Not sure what it looks like where you live, but it’s cold outside where I live in Upstate NY, and we’ve got plenty of the white stuff on the ground.
Whereas some friends might curl up with a good book, I tend to gravitate to puzzles and thought provokers when I’m indoors and have some time on my hands. So I thought I’d provide you with a few links and summaries. I’m curious about your opinions:
1. Scenario: Your Uncle Henry lives in Rural-alia and needs prostate surgery. His primary care doctor refers him to a general surgeon who provides Henry with a list of all the side effects and describes the surgery and potential, probably outcomes, including incontinence and impotence. Uncle Henry settles on a date for the surgery, but confides in you that he’s really frightened and does not want to live with those side effects.
Questions: Do you suggest to Uncle Henry that he go into the city to find a second opinion? Do you tell him there are newer forms of surgery that may minimize the chances for those outcomes? Is it up to the surgeon to explain to Henry that there are other hospitals and surgeons that can do a better job?
Background: Should patients be told of better care elsewhere?
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2. Scenario: Aunt Genevieve has been hobbling around for years on that bum knee of hers. She finally lets you talk her into visiting an orthopod, and he tells her she really needs to have her knee replaced. She follows through, the surgery and recovery are a bear, and she begins to have real problems almost immediately with the knee not really working right. Then, as you dig into more information for her, you find out her surgeon is actually one of the inventors of the knee which was used in the surgery.
Questions: Do you confront the surgeon about the problems? What do you ask him to do about them? And does it matter that he owns the patent (and therefore makes money) for the artificial knee? Should he have disclosed that fact to Aunt Genevieve?
Background: Don’t be a victim of medical marketing
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Thoughts on either one? Just hit the “add a comment” button below…
September 18th, 2008 by Trisha Torrey
I don’t usually write about local or state news because my work is really more broad than that — however — an article in my local newspaper about a local hospital and wrong-site surgery just begged for some additional information!
Wrong site surgery — a “never event” that takes place an estimated 100 – 200 times per year in the United States. In this case, the patient was supposed to have his fractured right hip replaced with a new one. However — the patient woke up in the recovery room with — surprise! — a new LEFT hip. Yes, the surgeon had replaced the wrong hip. And of course, the right hip was still in the same fractured state it began with.
I can only imagine that this mistake took place like most of the wrong-site surgical mistakes do. In a hurry (because, never forget – time equals cost), shortcuts were taken. And who pays the price? The patient, of course. Oh yes, the hospital will now pay a $ 6,000 fine, too — more about that in a moment.
According to the article and the New York State Health Department, this is what took place:
- Instead of marking the skin on the correct hip with a skin marker, the surgeon used a ball-point pen.
- + The surgical nurse didn’t know whether or not the skin had been marked, so he or she prepped the wrong hip.
- + The nurse who transported the patient to the operating room never verified the correct side either.
- + The “time out” process, which is required by the Joint Commission (the group that accredits hospitals) was not followed. (Of course not — time OUT is expensive!) There are actually three required Time Outs: 1 – before anesthesia, 2 – before any cuts are made, and 3 – post surgery, they are expected to account for all the tools and materials used that should not be left behind in the patient.
- + The MRI films were not displayed in the OR for review prior to the surgery.
= one patient who is far worse off than when he or she was admitted to the hospital for surgery.
There’s no mention of what happens to the medical personnel who made the errors. One can only hope they are being dealt with. (And I won’t even go into the hospital policies that caused them to take short cuts to begin with. Were they running behind? Were they pressured to make up time? No excuses — but I do recognize that the pressures on these folks are outrageous, and then, as usual, we patients pay the price….) But I digress…
The hospital was fined $6000. I wondered — who gets that fine money? Where does it go? Hospitals all over New York State (and every other state, too) get fined on a regular basis. Does the money simply enhance the general budget? (Are we going to try to make up for Wall Street’s woes by fining healthcare facilities?)
So I called the New York State Health Department. After several minutes of being passed around from one department to another — I actually found someone who was very helpful! Peter Farr, from the Bureau of Hospitals, explained that until recently all that money simply got deposited into the general fund. BUT! Recent new legislation has established the Patient Safety Center, and now most of the fine money will be funding that program. The Patient Safety Center will be tasked with transparency issues — reporting all that data that we patients have not had access to, but will begin seeing (and hopefully using) in the near future.
You know, though, we patients can all learn from this wrong site surgery story:
- If you will have surgery, mark the area of your body that is to be operated on. Use a marker that won’t wash or rub off right away (like a sharpie), and mark “THIS HIP” or “CUT HERE!” or whatever works for the surgery you’re about to have.
- Then mark the area that could be mistakenly opened. “WRONG HIP” or “NO! NOT HERE!” on parts that could be cut accidentally.
- Before they give you that pre-sleep drug, and anytime you see or encounter anyone who might be in the OR, remind them to take their “Time Outs.” Don’t worry about whether someone will be in the OR or not — assume they all will, and remind them all. Ask your loved one or advocate who is with you before your surgery to do the same.
I have to think that the surgical personnel at this hospital are just as appalled as anyone else about this mistake. They will be second-guessing themselves for a very long time, and I’m sure they will be correcting themselves and being far more careful in the future.
So my advice is simply for the rest of us to learn from their errors — and perhaps to think some good thoughts for that poor patient who had two hips replaced in one day, and will hopefully recover 100 percent.
(PS — If you are the patient, why not get in touch? We’ll keep your identity anonymous, but we’d love to hear your impressions…. email blog (at) epadvocate.com. )
