Written by Steven Burns
From his column To Your Health
I got the call from a nurse in the rehab center, asking me about one of my patients who had just been admitted. “Doctor,” she said, “your patient is demented, and we need something to calm him down at night. He is disrupting the other patients.” I was shocked. “He is not demented,” I said. “Three weeks ago, he was working as a consulting electrical engineer. He is having delirium from the medications and his illness. You just don’t realize how sick he is!” It took five minutes of explanation and a visit to the rehab center to convince the staff they were not dealing with an old man with dementia, but rather a functioning human being who had been dreadfully ill. Within a couple of weeks, my patient walked out of rehab and resumed his productive place in society.
So, what do you do if your loved one is being misunderstood, possibly mistreated, in a hospital or care center? First and most important, talk with the staff. Explain who your loved one is, and how he or she normally acts. If your loved one has dementia, explain to staff what you do to calm them down. Make sure their sleep is not being disturbed by unnecessary vital sign checks and blood draws in the middle of the night. Make sure staff members know to speak loudly enough when your loved one has hearing loss. Be there as much as you can, to observe and explain. And don’t hesitate to speak up if you see maltreatment. Some staff members do not understand that they must speak kindly, even if they think a patient cannot understand what is going on. You have the right and responsibility to complain if your loved one is not being treated well.
Hospitalization has become more complex than ever before. Most patients are admitted through the emergency department, which can be one of the most chaotic places on the planet. Then, insurers and Medicare or Medicaid have added rules on who can be admitted to a regular hospital room, and for how long. Many patients are placed in “observation status,” meaning although they are in the hospital facility, they are technically “not in the hospital.” It is like a limbo setting between emergency and a regular hospital room.
Quoting Medicare.gov: “The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care. But, your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.
“Each day you have to stay, you or your caregiver should always ask the hospital and/or your doctor, or a hospital social worker or patient advocate if you’re an inpatient or outpatient.”
The major difference between inpatient and observation is whether your costs are paid by Medicare Part A (hospital) or Part B (outpatient). Your status does not affect your quality of care or the services provided, but you might be in an emergency department for the entire stay, depending on the capacity of the hospital.
What can you do to help yourself while you are in the hospital? Mainly, follow directions. If you’re supposed to ask for help to get out of bed, then don’t decide to do it on your own. If you’re given a medicine, take it without too much fuss. But if it is making you feel sick, speak up. Your nurse can’t make the decision to stop a medicine, but he can call the doctor on your case, who can. If you’re getting physical therapy, work as hard as you can to do what the therapist requests. Ideally, you may have a family member available to back you up; if not, know your rights.
Now, what if the doctor comes in and says, “Okay, you’re ready to go home,” but you know you can’t walk, or are too weak to manage on your own? You have the right to protest an early discharge, and usually your request to stay longer will be honored, if there are still medical reasons to keep you.
What if you want out of this crazy place right now? Well, walking out “against medical advice” (AMA) can have both health implications and financial costs. If your doctor says you’re not ready, then you’re really, really not ready. They do not get paid more to keep you in the hospital longer than needed. Neither does the hospital. Listen carefully, and either your doctor or nurse can explain why you’re not ready to go home.
Last, remember that you have an advocate in your primary care physician, even if they do not go to the hospital, but they likely will not be contacted by the hospital. Even when staff say they will call your doctor, they usually do not follow through. You or your family need to call your doctor as soon as you get to the hospital. Your doctor may have information the hospital staff can’t know, and can call the staff to inform their treatment decisions.
Next time you find yourself or a loved one facing a stay in the hospital, I hope you will think of these suggestions. Being an advocate for the patient, cooperating with staff, making known your concerns, and keeping your primary care physician informed, can go a long way toward making a hospital experience better.
In closing, it has been my honor to write these articles for you for the last seven years. I’ve tried to give you good information in an entertaining way, and I hope I’ve succeeded. But it’s time to pass the baton. Special thanks to Mark Graham, my editor. He has cajoled, corrected, and chased me around when I’m late, all this time. He has become a cherished friend. And, of course, thanks to my editor-in-chief, Rev. Denise Burns, my wife of nearly 50 years. Also, thanks to you—the ministers and spouses of our church—for reading these words. God bless you and your family with peace and good health.
Dr. Steven Burns, M.D., is board-certified in family medicine and has been in practice for more than 30 years. Opinions are his own.