I don’t dispute the stress doctors and nurses must be under with their long shifts, the hospital bursting at the seams with patients and the high ratio of patients to nurses and doctors but do believe there are a few things that could improve. Admittedly, these suggestions and experiences are based on one week-long visit in one hospital but I suspect these could be universal.
1. Acknowledge the caregiver. The most welcome question I received all week was, “Are you his caregiver?” Yes! Yes, I am! Thank you for asking! I’m sure my face lit up when asked this question because it indicated to me this was someone who knew the importance of the caregiver and the vast amount of information I may have about Robert’s history and his “baseline” behavior and health. Unfortunately, the nurse who asked this only cared for Robert toward the end of his stay.
2. Keep the medication schedule the same. This is a tough one because I know it creates extra work for the nurses but I think it is critical in patient care. Many of Robert’s meds are written as “3x day” but he is on a very specific regimen for various reasons such as certain drugs shouldn’t be taken with other drugs and some meds need to be taken with meals and some thirty minutes before a meal (another reason my checklist comes in handy!). We have a very specific schedule we follow at home and if the goal is to get the patient well and to solve whatever medical mystery they currently have, why not keep as many variables the same as possible? Robert was extra lethargic during his hospital stay – was this because of the pneumonia, his lack of activity or the medication schedule being changed? The change for Robert wasn’t even consistent because he got moved around a lot. It all depended what floor he was on and what the nurses were willing to do.
3. Communicate with the family. During Robert’s hospital stay last May, I was familiar with each member of his medical team (Robert goes to a teaching hospital so there are a group of doctors who see the patients). The doctors were communicative and available and answered every one of my questions. This time, perhaps it was because Robert started in the ICU or because he was frequently moved to new rooms, but it was next to impossible to talk to his doctor. In the ICU, I learned to eavesdrop on the team who would discuss his case in the hallway outside his room. The doctors were all terrific but they rarely came into the room or gave me time to ask questions about what was going on. Once he was moved to a regular room, I actually had to have the nurse ask the doctor to call me since I never saw her. Aside from one day when I had to see the dentist, I was always at the hospital before 7:00 a.m. The rounds were supposed to be between 7:00 – 9:00 a.m. but I only saw the doctor once and that was on the day she released Robert. Any information I did get was from asking the nurses or when I insisted on a phone call from the doctor. There may not have been anything new to tell me but I don’t know that if someone doesn’t tell me!
1. Make assumptions. As much as computers are helpful in having the patient’s medical history available as well as what treatments and medications have been given, mistakes still happen. Twice I had to stop a nurse from giving Robert medication because he had already taken it. Once, the ER nurse was ignoring what I was trying to tell him and he gave Robert an extra dose of Depakote (and then tried to blame me). Another time a floor nurse was covering for the regular nurse who had left for break and she tried to give Robert the same medication he had been given an hour earlier.
2. Play musical beds. Robert was first in the ER on Friday and was transferred within hours to the MICU. By Monday, he was moved to the telemetry floor (where they still continuously monitor vitals). He was moved twice more before being released. I was told numerous times the reason for the constant moving of patients is because the hospital was packed. If the ER was full, they had to make room for those being admitted. Patients were wheeled from room to room on a daily basis. The downside to all this moving is the nurses do not get to know their patients which can hinder their ability to see a subtle change in health.
3. Say, “As I’ve already told you.” Really? Maybe I’m repeating the question because you didn’t answer me the first time or I didn’t think you understood my question so I rephrased it or gave you additional information. I heard this from the difficult ER nurse and from the doctor assigned to Robert. It’s arrogant and dismissive – please stop saying it.
While I try to be a helpful and grateful caregiver working on behalf of Team Robert, I would appreciate it if the doctors, nurses and hospital remembered we are on the same team. After all, we have the same goal: a healthy patient and to be able to go home. For the most part, the care Robert received was, as he says, "excellent." There were many, many caring nurses and other staff which was most appreciated during this stressful time. These suggestions are meant to be just a little fine-tuning!
What are your dos and don’ts for medical professionals?