It’s possible to become a patient-advocate without alienating
hospital staff. You can help your patient without getting in the way of
important tests, or hampering treatments
Doctors
are not super humans and they cannot cure all their patients. However,
sometimes they are so focussed on the technical aspects of the medical care
they provide, that they forget that a pat on the shoulder and a reassuring
smile can make a world of a difference to the patient.
As a patient-advocate, you
can help doctors and nurses deliver humane, compassionate and empathetic care
to their patients. You have the resources at your disposal. You have the
medical knowledge and you know how the system works. You know where to go for a
second opinion; and you know which hospital has the latest technology and which
doctor has specialised expertise. You know whom to contact in case of an
emergency, what forms to fill out; and what formalities to complete. You can
tap into your skills to ensure that patients are treated with love and care by
the medical staff.
It’s possible to become an
advocate without upsetting hospital staff. There’s no need to rock the boat and
put your patient’s life in danger. Being an advocate is all about being informed,
present, persistent, and caring. It is not about being loud, arrogant,
adversarial, or obnoxious. It’s a delicate balancing act, rendered with
humility and helpfulness, where everybody has to learn to be a team player.
Your
ultimate goal must be to establish a relationship of trust. For as long as you
are in the hospital, try not to throw your weight around, or come across as
uncouth; don’t over react over minor issues or pull strings to fix small
problems. Change the way you approach a nurse or ward boy for help. Use words
like “Help,” “Excuse me,” “May I,” “Thank you” and “Sorry” as often as you can,
before asking for a bedpan, a glass of water, a change of sheets, an extra
pillow etc.
You thank
people who serve you at restaurants, so why not do it in the hospital too? If
you are polite to nurses and ward boys, they will respond in kind. Have faith
in the system. Believe that everyone wants to be helpful. Saying a sincere
“Thank you” will make hospital staff feel good about their job and they will be
more polite in the future.
When a
doctor visits, listen carefully before you start bombarding him with questions.
Be prepared with your list of doubts. Don’t waste his time by beating about the
bush – this just irritates a busy doctor. Surgeons will always have one foot
out of the door, so prioritise your questions and get to the point quickly.
Some
staff members may still regard you as a nuisance. A few may appreciate your
efforts and others may feel threatened. Don’t put them on the defensive. Don’t
let the negatives of a situation vitiate the hospital environment. On the other
hand, don’t get cowed down by the hospital staff either. You are not there to
win a popularity contest - you are there to save a life. Not everybody has the
skill or ability of being able to connect with others quickly and easily, but a
good patient-advocate has mastered this art.
Because
patients can’t fight for their rights any better than defendants can argue
their own cases, or citizens can file their tax returns without the help of a
CA, patients need the help of a patient advocate to make their hospital stay
comfortable. In fact, progressive hospitals are investing in employing
professional patient-advocates, whose job it is to make the hospital more
hospitable. Patient advocates help to pamper patients, so that they go home
fully recovered, and full of praise for the hospital and the medical staff.
Most
doctors and nurses are professional and efficient in the discharge of their
duties. But you still need someone who will put the patient first when she is
in hospital - and no one can do this job better than a patient-advocate. An
advocate provides personalised care to the patient. Every patient is entitled
to the highest quality care - the kind a VIP gets when he enters a hospital.
Patient-advocates can help to resolve complaints; gather feedback about
hospital services; and implement suggestions to improve care and enhance
patient satisfaction.
These
professionals should not be viewed as competitors to the medical team, but as
partners who can fill the gap in services, and assist patients in negotiating
the complex healthcare system. The real value of a patient-advocate lies in her
ability to represent the patient - and every patient is special and unique. She
can assist the doctor in understanding the patient’s experience and her
personal preferences, so that the doctor can customise the solution he offers
to the patient. A patient advocate helps the medical team to deliver friendly
efficient and effective service, tailored to the patient’s needs, by being a
partner, teammate and personal coach. To illustrate, let me give you an
example:
A
37-year-old patient with a serious lung infection had to be shifted to a
ventilator and was put in a medically induced coma in the ICU. On the third
day, he suddenly became alert and couldn’t figure out where he was. His arms
were restrained and he could not spot any of his family members around him. He
had had a tracheotomy done two days ago to assist him in breathing so he
couldn’t even speak. When he came around, he naturally panicked and gestured
wildly to the nurse attendant in the ICU.
Thankfully,
she was a good nurse and she recognised that the patient was conscious and
anxious. She rushed to the patient’s side, took his hand in hers and in a soft,
crooning voice addressed him by name, while trying to assure him that
everything was alright and that the doctors were making sure that his lungs
were functioning normally. Then she offered to inform his family that he was
awake. While doing all this, the nurse took care not to let go of the patient’s
hand, made direct eye contact and spoke in a very warm, soft tone. The patient
quickly calmed down - and was full of praises for the loving care he received.
Another
incident that a five-year-old’s father once narrated to me was when he was
taking his toddler to a hospital for treatment of a profusely bleeding wound on
the scalp. He was frantically looking for a wheelchair for his son in the
parking lot, and although it was not his job, the parking attendant on duty
rushed to fetch a stretcher for the little boy, who was placed safely in good
hands in a few minutes. The parking attendant saw the father’s distress and
responded to it with urgency. To this day, this father has not forgotten that act
of kindness. The moral of the story is that everybody working in a hospital,
from the sweeper to the surgeon, has a moral obligation to be a patient
advocate. An example must be set by the senior management team, who should take
daily rounds, and visit each patient personally, so they can resolve complaints
before they snowball. The message will then percolate down all the way to the
ward boy - because staff members imitate what their bosses do - not what they
say.
All
hospital staff members must learn to read a situation from the patients’ point
of view. Surrounded by a battery of specialists — cardiologists,
endocrinologists, orthopaedists, neurologists, and more, patients are scared,
confused, and vulnerable. Specialists are often too busy to give their patients
the full attention they deserve. That’s when the others around them can step in
to fill the void. If and when the opportunity presents itself, the supporting
battalion of nurses, paramedics, ward boys, hospital administrators, and clerks
must serve as patient advocates. It costs them nothing, but can deliver rich
returns - both from the sense of personal satisfaction such acts of kindness
generate; as well as the resulting enhancement of the hospital’s reputation. At
the bare minimum, this would bring a smile to a harried patient’s face - and a
patient who goes home with happy memories of her hospital stay will become a
brand-ambassador for the hospital.
While all the hospital staff
(barring a few rotten apples) mean well and want the patient to get well and go
home as early as possible, sometimes they are spread too thin. After performing
ten surgeries in a day, a doctor can be expected to feel a little tired. A
nurse may be feeling low, because she has just done a double shift, or the
billing clerk may be cranky because he got ticked off by his boss – and in
those circumstances, they are not able to give tender loving care to the
patient - after all, they are human too. This is where a personal full time
patient-advocate can shine - and help patients get the care they want and need.
Playing the role of a
patient-advocate
Even if
you cannot afford a full time patient advocate, there’s a lot you can do
personally to advocate for your patient. Once you arrive at the hospital and
have provided staff with the information needed to admit or treat your loved
one, you should:
Find
out who the “attending physician” is. This is the person who will coordinate
and oversee your loved one’s care, work with consulting physicians and
specialists, and have responsibility for your patient’s treatment plan.
Get
the phone numbers for the attending physician and make sure that he knows how
to contact you directly regarding your loved one’s care.
Keep
a list of questions ready to ask your attending physician. You never know when
the doctor will show up by your patient’s bedside. A typical visit won’t last
more than 10 minutes. If, for some reason you won’t be in the room when the
doctor visits, leave your list with the nurse.
Introduce
yourself to the nursing staff. They will be providing the bulk of the hands-on
care to your loved one. They should be able to answer most of your questions on
medication, treatments or procedures. If they can’t, they will direct you to
another clinician who can. Nurses typically work on 12-hour shifts (i.e. from 6
a.m. to 6 p.m.) so find out when the shift change is and try to wait until the
nurse on duty has the information she needs to answer your questions.
Get
to know the hospital’s discharge planner or case manager. It is their job to
help with discharging your loved one and ensuring that you have all the
information you need before leaving the hospital. She can provide you
information about local resources, referrals to other medical professionals,
when to follow up, etc.
The above is an extract from Dr.Aniruddha Malpani's book : Patient Advocacy - Giving Voice to Patients
The book launch will take place on Saturday, 16 November 2013 at Hall of Harmony, Nehru Center, Worl, Mumbai - 400018 during the 4th Annual Putting Patients First Conference.
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