I’m getting to know our healthcare system a little more up close and personal than I’d like this week. My brother got hit by a car when he was out bicycling and had to be helicoptered to a trauma care facility. He’s doing better and may be moving out of the hospital and in with my parents tomorrow, but it was a weeklong lesson in how to get good healthcare in modern America.
1) Make sure you have insurance
Of course, hospitals are required to save the lives of anyone, regardless of their insurance status. But as important as that is, the lifesaving aspect of healthcare is just the beginning. I have to admit, I actually didn’t know if my bro had health insurance, and that was one of the first questions I asked his fiancee, who was with him when he was hit and has been at his side for every allowable minute since then. If he hadn’t had insurance, yes, they would have saved his life. But the first thing we would have started to do was worry about how it was going to be paid for. There are many more important things to worry about, such as making sure he gets good care, making sure we do everything possible to help him along, and setting things up so he’ll get care once he is out of the hospital. We have the luxury of knowing that he’s not going to spend every cent he has on this accident, but millions of Americans don’t have that luxury… yet.
2) Make sure you have a loving family and caring friends
When you’re spending a lot of time in a hospital, you start noticing the other patients, and the other patients’ families…or lack of family. For part of his stay my brother was next to another head-trauma patient. No one came to visit that young man. No one made sure he was comfortable outside of the few things hectic nurses can do for their patients. No one questioned his doctors on their decisions. No one brought him drinkable coffee from the Vietnamese cafe across the street. From the important decisions on down to getting your favorite snacks delivered, having your family around is extremely important. And it has to be family: Friends were not allowed in the ICU.
3) Corollary to #2: Make sure your loved ones are close by and can spend time with you
We have a family joke that we have contributed greatly to the population growth in California. I came here in the 80’s for college, and my entire family followed: 4 siblings with their eventual children, parents, cats, and dogs. So when my brother was hospitalized, we had enough people close enough to make sure someone was available at all times. Of course, none of us lives anywhere close to the trauma center where he ended up, but we could drive to get there. And a few of us had flexible enough schedules that we’d go to the hospital with our computers and smartphones and spell each other so we could get a little work done. But what if we’d lived across the country, or in another country? What if none of us had the ability to skip work? In my brother’s case, he wasn’t able to sign documents so he had to have a family member nearby at all times for the first few days. Though the staff at the ICU were kind in ignoring the fact that his fiancee wasn’t technically allowed to be there, they had to have a signature from an actual relative.
4) Make sure you have advocates
This is why #2 and #3 are so very important: when you’re in the hospital and not able to stand up for yourself, you need an advocate. This can be a close friend, but for legal reasons (see above) it helps to have family members (or a legal representative) who are there to sign for you. You never know when your job as an advocate will change from legal to something much more important. When my dad was admitted to the hospital a few years ago with extreme abdominal pain, my mother patiently explained to each person who took his health history that he only had one kidney. They all seemed to think this was not urgent. Finally the surgeon showed up. My mother asked him whether he’d noted on my dad’s charts that he only had one kidney—the surgeon was the first person who knew how important this information was and took it seriously.
5) Prepare ahead of time for disaster
I have found out in the last few years how few of my friends, most of whom are parents somewhere in my age range, have advanced directives or wills. Though paying a lawyer is, of course, the very best way to get this done, Nolo Press has done a great job of providing those of us who can’t afford a lawyer with instructions for putting together these very important documents. In case of disaster, does your family really know what you want done regarding healthcare and, in the worst circumstances, death? If both you and your spouse died at once, what will happen to your children? If someone has to make healthcare decisions for you, who do you want it to be? If you don’t have family, or if you are not close to your family, who do you want to be able to make decisions for you? All of these questions can be answered ahead of time, and they make it so much easier for the people you love to deal with a catastrophic health crisis.
We have been by and large impressed with the care my brother has received. The staff seems completely on top of things—computers have gotten rid of the many errors that came of scrawled charts hung on the ends of beds. And they are generally helpful and caring. But still, hospitals are places where lots of things can go wrong. If you want your family to get the best care, you have to be there, and be vigilant.
Well-said, and tremendously important! (Of course, those of us without families, well, it’s not easy to just acquire some…
My father-in-law was in the hospital for a while after “routine surgery”. Here’s a tip: there’s no such thing as “routine” abdominal surgery on someone who’s 83 and has already had one hatchet-job to the abdomen plus two surgeries to correct the damage left by the first.
But the family was horrendously frustrated — doctors never came around, nurse’s couldn’t answer all the questions and didn’t have time, my husband began to think that the frustration was actually helping to keep his father ill, so he flew there and uttered the magic words: “What is my father’s plan of care?” Apparently, the nurses didn’t figure they had to answer questions until the questions were put in the correct language, the right form of words.
As a result of the question, a doctor came in and said he was the family’s hospitalist. Hospitalist? He’s the point of contact for the patient and the family, and the coordinator of all medical care.
It would be nice if someone had told the patient and the family before day 10 of the hospital stay that there was such a thing as a hospitalist. Of course, the possibility exists that they had informed a sick 83-year-old man on his way into the OR that there was such a thing as a hospitalist, so here’s another tip: that’s not good enough. You cannot expect an ill person to retain and use that kind of information.
And besides, if the doctors don’t come around anymore because the hospitalist is there to do the job, why hadn’t the hospitalist come around, in *10 days*?
So that is, i suppose, mostly venting, but it’s also an “amen” re your post, especially the part about having an advocate. I’ve got it on my calendar now, to rejig the financial planning to take into account the fact that once the previous generation goes, I won’t have anyone but myself, my husband, and my sister. No family. So I’m planning for a paid advocate, the kind I once hired for my elderly mother since I was living so far away.
And even so, I’m still scared.
And I live in country where we get excellent government-paid, free (okay, from my taxes) health care — which is the biggest luxury of my life. I highly recommend it. My neighbors can’t figure out why Americans didn’t vote it in years ago.
Go figure.
That sounds just about typical for a hospital visit these days in many places. I noticed that the computer system really helped out in my brother’s case. I’ve been following articles in the New Yorker about efficiency in hospitals the last couple of years and I’m seeing the changes trickle in. At his hospital, my brother couldn’t receive any medication unless the person administering scanned his barcode first. (Very cool, though it’s a bit funny to be wearing a barcode.) So although we still questioned the nurse as to what he was getting, we had less worry that he was getting a double dose or someone else’s medication. Must be comforting to the nurses knowing that they don’t have to depend on their memories at the end of a long shift. Yes, it amazes me that people even listen to the crazy arguments against universal healthcare. It’s so much more efficient to treat people before the problems arise, in cheaper clinic settings rather than in the ER. People don’t realize that we’re ALREADY paying for uninsured people’s healthcare, just in the least efficient and most expensive manner possible. And it totally irks me that people have made this a party affiliation thing, when Obama chose the plan specifically because it was one that Republicans came up with. He and the Democrats could have chosen to use a Democrat-designed plan, but they chose to take the middle road and do what the Republicans wanted in hopes that conservatives would put politics aside and do the right thing. I guess that was a mistake, though I do think that at some point, all this stupid political posturing has to stop and things need to get done, one way or another. End rant for the day!