When Someone Is In The Hospital (November 11, 2014)
A longer version of this article was originally published by my friend Kelly Graham in the Autumn 2013 edition of UB GoodNews. She has kindly allowed me to slightly edit and re-print it here, along with my own underlinings and bullets for emphasis.
My intention was to talk about protection as it pertains to insurance, but some experiences I’ve had recently have brought me to discuss something slightly different: protection in health crisis situations.
One day this past spring my significant other, Hani, called my office and said he was headed to the emergency room because of his heart. Now, this is always a shocking call to receive, and for me it was also confusing. My sweetie is in great shape. He works in a physical job where he sweats every day, he played soccer 3 to 4 hours a day for 20 years, he eats a ridiculously healthy diet, and he is just 44 years old.
But here we were: he in a bed in the emergency room, and me sitting beside the bed waiting to find out why we were there. You see, he had no symptoms. No shortness of breath. No chest pain. Nothing. But still, we were in the ER.
The path to the emergency room was this: He had gone to his regular doctor with a bad cold. The doctor said his heart seemed to be skipping a beat and that Hani should follow up with a cardiologist. Said cardiologist fitted him with a halter monitor, and then called him 30 minutes later and said, "come to the ER." Hence our rendezvous.
And so we sat, with no symptoms, my darling in his dirty work clothes (he’s a carpenter), me in a suit with my briefcase (containing my cell phone and a bottle of water), and both quite confused.
We eventually learned that Hani had had an episode of ventricular tachycardia (V-tach) during his stress test with the cardiologist, and that the plan was to admit him to the hospital and perform an angiogram the next day, which would probably include an angioplasty to treat the expected blocked artery or arteries.
I noticed that whenever someone came in the room to talk to us, he or she would use terms I was not familiar with and talk about things of which I had no knowledge (like all the stuff in the paragraph above). So I started taking notes in the memo function of my smartphone. (I could have used a pen and paper, of course, but I didn’t have that and I did have the phone.)
Interestingly, I saw “No Cell Phone Use” signs all over the ER and the hospital, yet every single person who worked there was actively using his or her cell phone – receiving texts from the lab, emails from doctors, and calls from different departments (I asked). So bring your phone. And a charger (I now carry a wall charger in my car, along with the car charger).
I started writing down the terminology that was being used and asking for explanations. And I kept asking until I felt I understood. I wrote down things like "V-tach" and "arrhythmia" and "bigeminy" and "trigeminy".
For most of us, doctors are authority figures, and we are taught to listen to what they say. I suppose that generally that's fine. But in a very unfamiliar situation – in a life-and-death situation – I learned it can be smart to take notes, pay attention, and challenge assumptions.
It was really startling to me to find out that people in the hospital – that is, the nurses, the medical technicians, the ones who are supposed to be helping – don't always know what they're talking about.
Here's one example: we were interviewed ELEVEN separate times after Hani was admitted to the hospital. In each of those interviews, the questions were virtually the same: “What brought you to the hospital? Did you have chest pain? Did you have shortness of breath? Did you feel faint?” The answer to all, of course, was NO. “So why did you come to the hospital?” they would ask. And I would reply that the doctor requested he come to the ER because he had an episode of ventricular tachycardia.
In 8 of the 11 interviews the staff person then said, “Oh, he had a heart attack.” No, he didn't. Ventricular tachycardia is not a heart attack. It can lead to a heart attack, but V-tach in and of itself is not a heart attack.
It frightens me to know that if I had not asked all those questions about V-tach, and exactly what it is and what it means, and made notes during those conversations, I might have gone along with that wrong assessment of “heart attack.” In fact, often the technicians or nurses or “patient advocate” or whomever so vociferously insisted they were right that I would go back to my notes and read them out loud, until they, too, understood that V-tach is not a heart attack.
Why was that so important to me? Well, without the patient’s insistence that the information entered in the medical charts is correct, the person entering information in the computer will enter whatever his or her own thoughts are – and if he or she is of the opinion that V-tach is a heart attack – guess what? The next time that patient tries to get life insurance, or medical insurance, or needs to be screened for anything that requires looking at medical records (as do many jobs nowadays), those records will say he or she has had a heart attack. That can raise prices, eliminate opportunities, and – most important, in my opinion – color the perceptions of every other medical professional who sees the information. Future treatment will always be based on the “fact” that this patient had a heart attack, even though he did not.
Since this situation, I've talked to many people who told me that when they had to go to the hospital with a parent or a loved one, they were surprised to learn that the medical record contained all sorts of information that was not correct. And here's the thing: Your treatment in a medical emergency is based on what's in your medical history and what the doctor sees in front of him or her. So you want to make sure that record is correct.
So here are my suggestions:
Since this situation in May we have had several other experiences with hospitals: Hani has had follow-up work at three different practices; I was admitted with abdominal pain; a client had very involved and serious spinal surgery; etc. etc. etc. So now my “go to” gift for anyone entering the hospital is a spiral notebook with a pen attached to it with a ribbon, and the patient’s name written on the cover. And based on the experiences we’ve had, here are some additional recommendations:
Kelly Graham is recently discovering, after more than three decades as an investment advisor in Nashville, the potential payoffs that can result from investing in one's own health. She reads dr. diane's newsletter religiously.
--dr. diane holmes
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