The lessons I learned from being hospitalized have stuck with me and guided me in all of my practice.
Lifelong Learning in Clinical Excellence | May 31, 2018 | 6 min read
By Scott Vasher, MD, Johns Hopkins University School of Medicine
The practice of medicine is filled with paperwork, meetings, charts to complete, orders to sign, and myriad other tasks. With so many demands placed upon us, it’s important to remember that the patient is always the top priority. Having been a patient myself has made a remarkable impact on how I practice and how I interact with team members, colleagues, families, and patients.
While on vacation at a cottage in northern Michigan, enjoying water skiing and bonfires, the unthinkable happened: I became quite sick and needed to be hospitalized. This took place a few months before I applied to medical school and, though only a four-day hospitalization, the lessons I learned have stuck with me and guided me in all of my practice.
Here’s what I learned:
- Don’t be judgmental that the patient didn’t come to the hospital immediately when they started to feel sick.
It’s not their fault they don’t know SIRS criteria and don’t have a blood pressure cuff at home. People present whenever their innate sense of what’s wrong overwhelms their sense of denial of being sick. These competing interests lead to errors in both directions: the patient with a cold that will go away with supportive care versus the patient with bilateral obstructing kidney stones that stayed home with pain and altered mental status for 48 hours. People don’t have medical degrees; they present when they present, our job is to take care of them.
- If someone comes back to the emergency room twice in a brief time span, it’s reasonable to lower the threshold for admitting him or her.
Even if they only stay for an “observation” period. Trust that people know when something is wrong. The insurance company may disagree, but we care for patients, not the insurance company. Until the insurance starts to take some of the liability and examines patients, their retrospective input means nothing to me and doesn’t influence my care.
- Not all patients know how to be a patient.
There’s no instruction manual for how to be a patient. Nobody told the patient they would have to wait for 8 hours in the emergency room before being seen. Nobody told the patient that the doctor probably doesn’t know where the extra pillows are stored. Be helpful and work with them to understand how to navigate being a patient.
- People like to be told when the doctor may be in to see them, even if it’s a rough estimate.
Strategies include trying to round at the same time every day or educating your outpatient staff that it’s ok to give people an estimate of how far behind you’re running in clinic that day.
- No one’s life revolves around medical care.
People have jobs, families, and lives outside of the clinic and hospital. Try to be sensitive to that when scheduling appointments and making management plans.
- Sit down with the patient and talk to them like a person.
Nobody wants to have eight doctors trail into a room, surround the bed, and literally talk down to them. Find a chair, kneel down, do whatever you need, but make the patient feel like they can talk and ask questions. Everyone deserves this respect.
- Not everyone that is asking for pain medication is drug-seeking.
It’s tragically easy to become jaded in this regard while practicing medicine, especially with the opioid epidemic being so heavily assessed by the media. The world has flipped from “pain as a vital sign” to “opioid addiction kills.” When patients have pain, remember that their behavior will change over time. Most people can tolerate pain for a few minutes, often a few hours, and sometimes a few days. But when pain starts to last more than a day or two, nearly everyone will start to act “like a drug-seeker.” It’s human nature to not want to suffer, not necessarily an addict in the making. Remember that there are alternatives to opioids and that different types of pain respond differently to adjunctive therapies.
- Medicine is a language and not everyone speaks it.
It’s incumbent upon us to rapidly make an assessment of a patient’s health literacy and speak to them on whatever level they need. That’s part of the job that we signed up for. It’s a reasonable expectation that we can speak on any level ranging from illiterate to professional degree.
- People don’t understand why it takes time for treatments, medications, procedures, and scans to occur in the hospital. It’s reasonable to explain this to them.
In my experience both as a patient and physician, people appreciate the explanation that shared resources in a hospital are divided based on a combination of acuity and availability. Being moved to the front of the line, while sometimes satisfying, usually suggests an emergency situation. Being the patient that needs something emergently is rarely a good thing. When put in perspective, I have generally had positive feedback from patients.
- It’s important to tell people when they’re going to have to do something unpleasant.
For example, drinking contrast is unpleasant and it’s the physician’s job to explain this to the patient. People are entitled to be told if they need to drink a gallon of bowel prep before the container shows up at the bedside.
- The notion that people “need their rest” in order to recover from an illness is antiquated and people should be re-educated about this.
It will take many years to change this culture, but people can and will understand this if told properly that laying in a hospital bed not moving causes loss of muscle mass and prolongs their convalescence. Get the patient out of bed, get them to a chair, and, if safe, let them walk around and keep their “land legs.” It’s very easy as a patient to lose track of this and several days into admission find that getting out of bed causes orthostasis and dyspnea. These things are partly inevitable but can be mitigated.
- It’s not the patient’s fault they need a letter for work.
These can be written very quickly and it’s not worth fussing about it. They have no more ability to control their workplace’s policy than we do.
- Not everyone knows how to make their follow-up visits.
We have a tendency to feel that patients need to take ownership of their care. While this is certainly true and patients should self-advocate, they may need to be taught how to take ownership of their care. Give them the right phone numbers and tell them what to say and how to ask for what they need.
- Everyone learns differently.
Not everyone will absorb an hour-long conversation about next steps in the workup of a malignancy. Adapt to the learning style of the patient. Show them the images, write things down, or do whatever the patient needs to help them understand.
- Food is important to everyone.
We’ve all experienced the “urgent” page for a diet order. Remember, the patient may have gone days without food. Try to remember the last time you had to delay your morning coffee by an hour, and then imagine how much worse it would be if you also didn’t feel well. Feed them unless there’s a reason not to. If that’s the case, then it’s our job to tell the patient why.
At the end of the day, being a patient is unpleasant. Nobody wants to feel sick and nobody wants to be admitted to a hospital. There are many things that we can do to make the experience less unpleasant, and hopefully this list is helpful in putting the patient experience into perspective.
I made a complete recovery after my time in the hospital and I’m happy to say that my experience was generally positive. The doctors, nurses, nursing assistance, phlebotomists, house-keeping staff and countless others all demonstrated a good approach to many of the points listed above and this instruction was pivotal in showing me how to be a good doctor.