One of the easiest things to do to ensure the best care possible while in the hospital is to always carry a list of your current prescription medications (including dosage, frequency and who the prescribing physician is), a list of medication allergies AND a list of food allergies. Having that list with you or easily accessible on a smart phone or via Internet makes it very easy to share the information. Hospital stays tend to be fairly emotional, so keeping important information handy makes it easy to share with medical staff without having to rely on memory.
Iatrogenesis is defined as: inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon. In simple words, iatrogenesis refers to death or injury caused by physician error or hospital error. We shudder to think such a thing exists, but it exists in much higher numbers than you might think. In 1999, The Institute of Medicine cited extremely high rates of iatrogenesis in hospitalized patients as a result of medical error and negligence that largely resulted from system failures. Reviews of multiple studies done on hospital safety found that up to 36% of hospitalized patients suffer complications or additional illness from iatrogenesis and that 50% of those events could be prevented. It is also estimated that 6.5% of iatrogenic complications result in permanent disability or death. (For an in-depth look at iatrogenesis, please read my friend Andrew Robbin's book, Licensed to Kill: The Growing Epidemics of Iatrogenic Disease And Bureaucratic Madness.)
Although most people receive excellent care while in the hospital, these numbers are significant enough that we should all use some common-sense precautions while in the hospital or caring for someone who is. My recommendations follow.
- Don't Hesitate to Ask Questions: I think many people desperately want to trust their doctors, so they fail to ask the questions they should be asking. I personally experienced this while my daughter spent two weeks in neonatal intensive care. She suffered an extreme level of malpractice resulting in severe iatrogenic complications simply because I so desperately wanted to trust that her specialists knew what they were doing that I didn't ask questions that should have been asked. In my case, I didn't do what was needed until a specialist from another hospital who was called in as a consultant pulled my husband aside and told him ... and I quote ... "You need to get your daughter out of here." I understand that sometimes people aren't willing to ask questions simply because they want to trust that their family member is getting the very best care possible. I've been there. It is still acceptable and necessary to ask questions even when your loved one is receiving the very best care available. If you don't understand what procedures are being done, or are curious about why they are being done, please ask. Your medical team has a responsibility to ensure you understand everything being done to help your loved one. If you have questions or if anything is even mildly unclear, ask them to clarify. Please don't feel rushed. Take your time and ask as many questions as you need to. As questions come to mind after the doctors leave, write them down and ask them the next time a doctor is present.
Also take advantage of the knowledge your nursing staff has. Nurses have an amazing wealth of knowledge and are happy to share information and answer the questions they are legally allowed to. I have friends who are nurses who have said they often wish patients would ask more questions. Please also don't hesitate to openly share if you aren't sure a procedure should be performed. If you question the necessity or timing of a procedure, do your research and openly share your concerns. Remember that you are a customer, not just a patient, and that you can choose to accept or deny any service or provider offered. Most hospital services are obviously necessary and should be accepted, but there are times that asking the staff to dig deeper before performing a procedure is perfectly fine. Be aware that you have the right to refuse a procedure or to request a different doctor if you are uncomfortable with anything related to the procedure. This leads us to my next point ...
- Know Your Rights: Be aware that you are not a "prisoner" of the hospital and that you are guaranteed certain rights. Top among those rights is that you are legally entitled to see your file/chart or the chart of your family member without having a doctor present. Spouses are allowed to view spouse's files, and other family members can view charts with the patient's approval. Many hospitals twist HIPAA laws and try to make it impossible for you to view your own file. A common tactic is to say that your file can only be viewed in the presence of a physician. This is, quite simply, illegal. HIPAA laws are in place to guarantee patient rights, not to make it impossible to review your records. If you ask to view your file or your spouse's and are refused access, let the staff know you are aware of your rights and politely but firmly demand access. If you are still refused access, call the hospital's HIPAA office and speak with someone to request access. If you are still not allowed to view your chart, call an attorney. Your medical information is, quite simply, legally yours and you are legally entitled to have full access to it. Period. If you are denied access, persist until you are granted access. Another trick they use is to say they cannot provide copies of test results until after the patient is discharged, at which point they charge up to $5/page for the copies. Don't let this happen. Demand they grant your legal rights. Some people choose to get around the hospital red tape by having all records sent to their primary care physician and then getting copies from that doctor. This method takes much longer, but can be easier if you are not comfortable being assertive.
- Monitor, Monitor, Monitor: I want to very clearly state I commend the doctors and nurses who work in hospitals. They face incredible stress and pressure on a daily basis and manage to rise above it to provide top-notch service and care. As much as I admire them, it can't be denied that they are human. Humans sometimes make mistakes. I am thankful that multiple checks and balances are in place to ensure mistakes don't happen in medical settings, but they still do. I know medication errors happen because I've had it happen ... twice ... in two different hospitals. I was brought the wrong medication on two different occasions. Had I not asked what I was being given, I would have taken the wrong medication. In one case, the error could have been deadly. The problem with medication errors is that they create the potential for a cascade effect. If you are given someone else's medication, it creates the chance the other person will also be given the wrong medication, so on and so forth. ALWAYS ask what medication is being administered before taking it. Always. This includes asking what bags are being hung on IV poles and what medication is being injected into IV tubes.
This is especially important if you have medication allergies. Always, always ask before taking anything or allowing it to be added to your IV. If you have medication allergies, hang a sign on your IV pole clearly indicating your allergies. Please also monitor your meal tray, especially if you have food allergies. Also be careful if you are taking a medication that should not be taken with some foods. For instance, people taking Coumadin are typically advised not to eat broccoli, yet broccoli is often served in hospital meals without regard for medications being taken. I've seen it happen. Be careful. Also monitor the timing of medications. If a medication is supposed to be administered every four hours, you may need to request it. Give the nurses a 10-15 minute window of good faith, then politely request the medication if it has still not been administered.
- Bring Your Own Food: I'm not kidding. Hospital food is basically the same as what is served in fast food restaurants. It is highly processed, not organic and is laden with chemicals. It's also just plain NOT healthy. Since it doesn't taste good, bringing your own food shouldn't be an issue. It amazes me that mainstream doctors admit whole foods are healthier, yet the food given to patients who are at their most vulnerable and who need the purest form of nutrition for healing is the farthest thing from whole food. Salads are made with iceburg lettuce, which is nutritionally void, all bread and breading is made with white flour instead of whole grain flours, and white sugar is added to almost everything. They also serve Splenda as a sweetener, which I think is criminal. Read my post on why you should never use Splenda here: http://bit.ly/pWYIzF.
One hospital tray I was recently "privileged" to view contained EIGHTY grams of carbs in a single meal. In my opinion, the highest number of carbs advised in any single meal is 30-45. (That's 2-3 servings of carbs. MORE than enough.) Eighty grams of carbs in a single meal is enough to guarantee high blood sugar and obesity in a short time. Hospital food seems to be designed to guarantee that people eating it become repeat customers. Bring your own food and ask family members to bring whole, organic foods as gifts. You'll heal more quickly as a result.
On an interesting side note, I failed to take my home made hand sanitizer with me, so I was forced to use the hospital's. Check out my post on Why You Should Never Use Hand Sanitizer: http://bit.ly/nNGDM7 for more info on why this concerned me.
A related post is one that could potentially help keep you out of the hospital: Top Three Blood Tests Almost Everyone Should Request: http://bit.ly/plpX7T
iatrogenesis. Dictionary.com. Merriam-Webster's Medical Dictionary. Merriam-Webster, Inc. http://dictionary.reference.com/browse/iatrogenesis (accessed: October 17, 2011).
Patrick A. Palmieri, et al. (2008). "The anatomy and physiology of error in averse healthcare events". Advances in Health Care Management 7: 33–68. doi:10.1016/S1474-8231(08)07003-1
Brennan TA, Leape LL, Laird NM, et al. (1991). "Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I". N. Engl. J. Med. 324 (6): 370–6. doi:10.1056/NEJM199102073240604. PMID 1987460
Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.
Quality Interagency Coordination Task Force. Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact. Washington, DC: Agency for Healthcare Research and Quality, 2000.
Szasz, Thomas S. Pharmacracy: Medicine and Politics in America. Westport, CT: Praeger Trade, 2001.
Tassano, Fabian. The Power of Life or Death: A Critique of Medical Tyranny. Oxford: Oxford Forum, 1999.