Written by Steven Burns
From his column To Your Health
I had gone to the hospital to see two patients. After the first visit, I realized I would not be seeing the second one. Walking to the emergency room was difficult (it is a large medical center), but I made it. I walked up to one of the emergency doctors I knew, and said, “I don’t know what’s going on, but I’ve got the worst bellyache I’ve ever had in my life.” “You’re probably not usually that color, either,” he said, referring to my slightly greenish skin tone.
Seven days later, I went home, having been treated for diverticulitis. Two months later I had surgery. That was 17 years ago, but I still remember the helpless feeling of being a patient. Between drug side effects, various procedures, and at one point being told, “Oh, you’re still here—the computer says you’ve gone home,” I felt sad, angry, helpless, and just really sick the whole time. Being a physician in that hospital did not shield me from most of the ignominy of lying in a bed with IVs and too-busy nurses.
I’m sure many of you have had similar experiences. Over the years, hospital experiences have worsened substantially throughout the world. The pandemic has caused many nurses and support staff to leave the field altogether, making those who remain even more overwhelmed than before. Nurses now take care of more patients than ever, and have higher burnout rates. In the United States, the patient-to-nurse ratio for a standard medical-surgical unit is supposed to be up to 5 patients per registered nurse. But a 2020 study showed ratios were nearly double this, up to 9.7 patients for each nurse in some Illinois and New York hospitals. Another study showed harms to patients increased along with ratios. In other countries, including Japan, up to 15 patients per nurse is standard.
So, with all that bad news, what should you do if you land in a hospital? The answers are different if you have family and friends to help, or if you are alone, so I will give tips for both situations.
1. Once you are settled in a bed, try to relax. This is hard when you are in pain or anxious about what is going to happen, but it is important in your recovery.
2. Realize the people treating you are trying to do their best, but they are humans, not machines. Be patient, and respond to them as you like to be responded to.
3. Ask questions—but not too many. Asking what medicine you are receiving is reasonable, and the nurse administering it must be able and willing to answer. However, nurses don’t have 20 minutes to explain the reason for every pill or injection you receive.
4. Have a pad and pen beside your bed to write down questions for doctors and nurses. That way, when they visit you’ll be able to recall information you’d like to ask about.
5. Make sure your family and friends know you’re there, and set boundaries on visitation. You need to rest, and having several people talking to each other in the room will not help. Hospitals have rules, but staff frequently do not have time to enforce them.
6. Allow yourself to be cared for. The term is “therapeutic regression,” meaning you allow others to assist you, and don’t refuse to allow their help. For instance, don’t get out of bed on your own if you’re supposed to ask for help. A fall will complicate and extend a stay.
7. When you push the button for the nurse, realize it will take a while for one to come. Remember they have at least 4 other patients, all likely as sick as you are, who need their attention. Again, be patient.
8. Where possible, designate a family member or friend as your advocate. Most of the time, this will be a spouse or adult child, but it can be anyone who knows you well. This person should be the one who talks with staff, doctors, social workers, and billing people for you. If you don’t have someone like this, request a social worker (most hospitals have them), and tell them why you need their help. Some hospitals have an ombudsman who can assist when complaints are serious enough to threaten your well-being. Take advantage of their services if needed.
9. The most powerful person on any hospital floor is the charge nurse. She can make things happen when no one else can, and typically has great authority, sometimes including the ability to get a consultation with a specialist if your hospital doctor is not responsive. But calling for the charge nurse is a bit like pulling the fire alarm. If you call her because your water jug hasn’t been filled on time, she might not be there when you really need her.
10. You can refuse care. Full stop. If you don’t want to have a medicine or treatment, you have the right to refuse. Most of the time, you shouldn’t do so, but if you feel there may be harm from a treatment, you may be right, so question treatments if they don’t seem correct to you. You may have information about allergies and side effects the staff person does not know, so speak up.
When you enter the hospital, you will be asked whether you want to be resuscitated in the case of impending death. Do not take this decision lightly. Ideally, you will have a living will and medical power of attorney designated well before your hospital stay. If you don’t have these forms, drop this article right now and get them. Some states have a website (in Arizona it’s the state attorney general) where you can get the forms. Download them, fill them out, and have a friend or family member witness your signature. Then, make sure your family knows where the forms are located.
If you are a family member of someone in the hospital, modify and apply the notes above to your loved one who may not be able to speak for themselves.
Next time, we’ll talk about emergency rooms, such ideas as “observation status,” and being discharged when you are not ready.
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.