Surviving the hospital: a primer - Tilted Forum Project Discussion Community

JustJess · 11-29-2006, 08:14 AM

Men's Health article
According to the article, hospital-borne infections are the 4th leading cause of death in the U.S. That's pretty friggin' scary (especially since I plan to work in a hospital as a health care provider very soon). Is this a concern to most people? Do you notice if your MD/health care provider has washed their hands?

This is full of good and interesting advice - I especially like the idea of carrying medical info with you on a USB drive. Hospitals are becoming more and more technologically advanced, with more computers available to the staff than ever before. They're beginning IT protocols in many hospitals to have computers on wheels, so the nurses, docs, and PAs can take their PC with them from patient to patient. It would be easy to open a USB drive and instantly have your records accessible. Especially since medication errors are huge source of trouble as well - if they know everything you're on and the dosages (and aren't relying on your memory or just a bottle), they're less likely to make a mistake.

I think this brings up the interesting issue of how savvy the average patient is. In my grandmother's time (DOB 1917), you just did what they told you. Now, I go in knowing what's wrong with me half the time and just needing the doctor to confirm and prescribe appropriately. 2nd opinions are de rigeur for many specialties (and for higher socio-economic groups).

How much of this information is surprising to you? Are you more likely to educate yourself now? Do you know where your nearest ER is, and what their environment is like? If you don't have chronic health problems, do you even think about this stuff? How many of you treat the ER as your primary care, not having a regular MD to do so?

I can post more of the article if y'all prefer.

EDIT:Hmmm... as I finally make it to the end of the article, there are a few things I disagree with.

Quote:

Scrub off the bugs
Five days before scalpel meets skin, start taking two showers daily, washing with an antiseptic cleanser like Hibiclens, which contains the antibacterial agent chlorhexidine gluconate. "Some studies show that it reduces the risk of infections," Larson says.

I'm torn on this. There's something to be said for preparation, but I'd want to run this idea past the doctor first. And there's also the concern about killing too much of your natural flora/fauna, causing you to be more susceptible to germs when you're done. Like the reasons why you shouldn't douche - if you ever *stop* douching, you'll end up with infections from everything suddenly growing back. A certain amount of bacteria etc. is normal, natural, and healthy for us to have on our skin. Like a symbiotic relationship. So I dunno... could that make you MORE susceptible while in hospital? Since you won't be doing that routine there?

Quote:

Empty the O.R.
Can too much care kill? A new Dartmouth study shows that the more money a hospital spends on a single patient's care, the poorer the outcome of the treatment. More cash means more physicians per patient, says Skinner, the lead author. "It's hard to get eight or nine doctors to agree and communicate well." Ask that unnecessary personnel, such as medical residents, be kept out of the O.R.

This, I just plain disagree with. How do you expect residents to learn? You want them to show up as autonomous MDs with no hands on experience? Or is it "that's okay, just not on me"? I also find that ridiculous. It's not like a resident - or even a fellow - is allowed to be in surgery or treat patients unsupervised. They are standing right next to each other, assisting each other. It's necessary and not something I think we need to make people paranoid about.

Quote:

Pop the question
As in, "How long have you been doing this?" The ideal nurse has been in the same unit, the same specialty and the same hospital for more than a few years. (Don't assume that an older-looking nurse is the most experienced. "More people are going into nursing when they're 40 or 50, and they may be less experienced," says Sean Clarke, Ph.D., R.N., associate director of the University of Pennsylvania's Center for Health Outcomes and Policy Research.) Because of the current nursing shortage, you may not have much choice in terms of who cares for you, but if you have concerns about inexperienced nurses, talk to the nurse manager.

HAHAHAHAHAA - Dudes, the shortage is freakin' high. We need new grads like you wouldn't believe. And even if your nurse is new to cardiology, but used to work in the ER for 5 years - you'll be fine. Really. Rather than worry about how long they've been a nurse, ask what the hospital orientation is like. Even if you're new, if the hospital puts you through your paces thoroughly when you start, the nurse will be juuuuust fine.

Just some more thoughts...

sapiens · 11-29-2006, 09:47 AM

Quote:

Empty the O.R.
Can too much care kill? A new Dartmouth study shows that the more money a hospital spends on a single patient's care, the poorer the outcome of the treatment. More cash means more physicians per patient, says Skinner, the lead author. "It's hard to get eight or nine doctors to agree and communicate well." Ask that unnecessary personnel, such as medical residents, be kept out of the O.R.

JustJess, in addition to your rationale:

Difficult, life-threatening illnesses cost more to treat and have a higher mortality rate. (Possibly producing the effect described in the study).

snowy · 11-29-2006, 10:22 AM

My mother got a staph infection a few years back after having surgery on her ankle for scar tissue removal. The problem was that the doctor had overcauterized the area, and that helped the infection to grow.

She had to be on antibiotics for quite a while after that, and got a free surgery for her other ankle out of it.

I'd say probably the best defense one can take is to look at the hospital's record of infection post-op/post-treatment and decide from there, if you have more than one hospital to choose from.

As for medical literacy--I am highly medical literate. My mother comes from that "you just do what the doctor tells you" mindset. Unfortunately this has caused her some problems, as she doesn't notice sometimes when her medications cause side effects. She just thinks it's something new.

My childhood doctor tried to convince me to go into medicine. I said I was majoring in English. She said that was fine--but to complete my pre-med classes just in case. Kinda wish I'd taken her advice if I'd known I was going to be in school this long anyways.

JustJess · 12-01-2006, 05:20 AM

The infection rates are a good indicator - but you have to take them in context. For instance, at the hospital that I work at, the morbidity/mortality rates are extremely low. That said, we don't have an ER - we're just a specialty hospital. So that sounds great, but it's not actually that impressive. And ERs are bound to have high rates of death and infection due to environment and the types of patients/cases that come in.

A LOT of the people I see coming to the ER that I volunteer for do not have primary care doctors, and are using the ER for that purpose. So it seems to me that they're wasting their time and putting themselves in unnecessary contact with really sick people. But I see very little of the "do whatever the doctor says" mentality anymore - it seems like more people are looking to disagree than listen at all.

magictoy · 12-03-2006, 10:14 AM

So how do you check a hospital's nosocomial infection rate?

JustJess · 12-04-2006, 07:17 AM

The HealthcareChoices site has a lot of info on practices at hospitals, and US News & World Report ranks all the hospitals in the country in terms of infection rates, morbidity/mortality rates every year. Certainly, you'll want to check to make sure any hospital you go to is JCAHO-accredited. It's a regulatory agency that ensures compliance with certain Federal regulations as well as making sure you're in compliance with your own policies. They have National Patient Safety Goals that all accredited hospitals must meet to maintain accreditation.

But... as of 2005, there was not a specific way to check rates on any particular hospital. ABC Story The Consumer's Union has links to state regs for 2006 and info about a Bill being considered to address the issue. But evidently hospitals do NOT want to publish their infection rates.

Cynthetiq · 12-04-2006, 07:30 AM

Quote:

Originally Posted by JustJess

The HealthcareChoices site has a lot of info on practices at hospitals, and US News & World Report ranks all the hospitals in the country in terms of infection rates, morbidity/mortality rates every year. Certainly, you'll want to check to make sure any hospital you go to is JCAHO-accredited. It's a regulatory agency that ensures compliance with certain Federal regulations as well as making sure you're in compliance with your own policies. They have National Patient Safety Goals that all accredited hospitals must meet to maintain accreditation.

But... as of 2005, there was not a specific way to check rates on any particular hospital. ABC Story The Consumer's Union has links to state regs for 2006 and info about a Bill being considered to address the issue. But evidently hospitals do NOT want to publish their infection rates.

I would think that it is because people have a hard enough time going to the hospital as it is let alone if there are facts and figures that without proper context and interpretation will scare them off.

I grew up in hospitals as my mom worked in 2 for over 20 years. She has dealt with hospitals around the world for another 20. While she can assuage most of my fears for most of the illnesses and procedures I have had, it still doesn't make me feel any better about going to the hospital for any reason knowing that there are incompenet staff, nurses, and doctors out there who's simple mistake may cause the death of one person if not many.

Sage · 12-04-2006, 07:48 AM

Quote:

Certainly, you'll want to check to make sure any hospital you go to is JCAHO-accredited.

It's kinda like when you were a kid and knew your parents were watching- you'd act all nice and sweet and polite. But as soon as their backs were turned, you'd shove some kid down and make him eat dirt because he took the toy you were playing with. At the hospital I worked at, they were all proud and parading around all the awards they got- while having the most utterly incompitent and uninterested Lab staff and the most unprofessional nurses ever. I have told my husband that unless it's a life or death situation I do not want to be taken to the hospital that I used to work for.

Honestly, I'd say find someone who works in a core area in the hospital, like the Lab, and ask THEM their opnion of the hospital and its care. I knew all the dirty little secrets of the hospital that JCAHO never saw and the public never knew about. I don't mean to scare you away from hospitals or anything, just know that you really never know what's going on behind the scenes of a large corporation (and they are corporations) like a hospital.

JustJess · 12-04-2006, 08:07 AM

Thus the point of the article! So that you can arm yourself, make yourself educated about these issues, and make sure that those in charge of your care take care of you.

Cynthetiq · 12-04-2006, 09:06 AM

One of the problems to also consider tho is when you are in an ambulance.... you don't get any choice as to where they are taking you.

Also, in most metropolitans there are many choices of hospitals, but in the suburbs there aren't so many choices. People look at what schools are good and that adjusts for hosuing prices, but not better or worst hospitals. People tend to go to the closest ones or the ones that their doctors are affilliated, yet more to make the choice difficult.

JustJess · 12-04-2006, 09:10 AM

Actually, that's not true - you can have the ambulance take you to your preferred hospital, and they'll oblige as long as there aren't other mitigating factors (severity of issue, your hospital overcrowded currently/can't handle your issue, etc.). That's why you should know what medical centers are closest to your house - know what you're getting into, at the least.

Cynthetiq · 12-04-2006, 09:38 AM

More often than not if you are in an ambulance, you aren't in the condition to pick and choose where you are going, which is what my point was. More often then not we don't have as much choice and control as we think we do especially in emergency situations.

Remember that time that Quadro's father tried to kill me, the first thing my mother did was check into the status of the medical center, but that was post admission. For the most part by that time it was too late, you're exposed to infection.

Luckily when I was in Long Island I did have 2 hospitals equidistant from my house. I also had the pleasure of going to both ERs and seeing the difference of how they handled patients. I did not spend any time looking at any of the infections, certifications etc, but I do know that one treated me more respectfully than the other.

JustJess · 12-04-2006, 10:00 AM

Agreed - and it's easier to be picky when you live in NYC and have a multitude to choose from. I'm not sure why this means you wouldn't want to be educated on the hospitals in your area, though - the more you know, the more likely you'll survive!

11-29-2006, 10:22 AM	#3 (permalink)
snowy Kick Ass Kunoichi Location: Oregon	My mother got a staph infection a few years back after having surgery on her ankle for scar tissue removal. The problem was that the doctor had overcauterized the area, and that helped the infection to grow. She had to be on antibiotics for quite a while after that, and got a free surgery for her other ankle out of it. I'd say probably the best defense one can take is to look at the hospital's record of infection post-op/post-treatment and decide from there, if you have more than one hospital to choose from. As for medical literacy--I am highly medical literate. My mother comes from that "you just do what the doctor tells you" mindset. Unfortunately this has caused her some problems, as she doesn't notice sometimes when her medications cause side effects. She just thinks it's something new. My childhood doctor tried to convince me to go into medicine. I said I was majoring in English. She said that was fine--but to complete my pre-med classes just in case. Kinda wish I'd taken her advice if I'd known I was going to be in school this long anyways. __________________ If I am not better, at least I am different. --Jean-Jacques Rousseau

12-01-2006, 05:20 AM	#4 (permalink)
JustJess Unencapsulated Location: Kittyville	The infection rates are a good indicator - but you have to take them in context. For instance, at the hospital that I work at, the morbidity/mortality rates are extremely low. That said, we don't have an ER - we're just a specialty hospital. So that sounds great, but it's not actually that impressive. And ERs are bound to have high rates of death and infection due to environment and the types of patients/cases that come in. A LOT of the people I see coming to the ER that I volunteer for do not have primary care doctors, and are using the ER for that purpose. So it seems to me that they're wasting their time and putting themselves in unnecessary contact with really sick people. But I see very little of the "do whatever the doctor says" mentality anymore - it seems like more people are looking to disagree than listen at all. __________________ My heart knows me better than I know myself, so I'm gonna let it do all the talkin'.

12-04-2006, 07:17 AM	#6 (permalink)
JustJess Unencapsulated Location: Kittyville	The HealthcareChoices site has a lot of info on practices at hospitals, and US News & World Report ranks all the hospitals in the country in terms of infection rates, morbidity/mortality rates every year. Certainly, you'll want to check to make sure any hospital you go to is JCAHO-accredited. It's a regulatory agency that ensures compliance with certain Federal regulations as well as making sure you're in compliance with your own policies. They have National Patient Safety Goals that all accredited hospitals must meet to maintain accreditation. But... as of 2005, there was not a specific way to check rates on any particular hospital. ABC Story The Consumer's Union has links to state regs for 2006 and info about a Bill being considered to address the issue. But evidently hospitals do NOT want to publish their infection rates. __________________ My heart knows me better than I know myself, so I'm gonna let it do all the talkin'. Last edited by JustJess; 12-04-2006 at 07:22 AM..

12-04-2006, 08:07 AM	#9 (permalink)
JustJess Unencapsulated Location: Kittyville	Thus the point of the article! So that you can arm yourself, make yourself educated about these issues, and make sure that those in charge of your care take care of you. __________________ My heart knows me better than I know myself, so I'm gonna let it do all the talkin'.

12-04-2006, 09:06 AM	#10 (permalink)
Cynthetiq Tilted Cat Head Administrator Location: Manhattan, NY	One of the problems to also consider tho is when you are in an ambulance.... you don't get any choice as to where they are taking you. Also, in most metropolitans there are many choices of hospitals, but in the suburbs there aren't so many choices. People look at what schools are good and that adjusts for hosuing prices, but not better or worst hospitals. People tend to go to the closest ones or the ones that their doctors are affilliated, yet more to make the choice difficult. __________________ I don't care if you are black, white, purple, green, Chinese, Japanese, Korean, hippie, cop, bum, admin, user, English, Irish, French, Catholic, Protestant, Jewish, Buddhist, Muslim, indian, cowboy, tall, short, fat, skinny, emo, punk, mod, rocker, straight, gay, lesbian, jock, nerd, geek, Democrat, Republican, Libertarian, Independent, driver, pedestrian, or bicyclist, either you're an asshole or you're not. What's the best nation in the world? DO-NATION!

12-03-2006, 10:14 AM	#5 (permalink)
magictoy Crazy	So how do you check a hospital's nosocomial infection rate?

12-04-2006, 09:10 AM	#11 (permalink)
JustJess Unencapsulated Location: Kittyville	Actually, that's not true - you can have the ambulance take you to your preferred hospital, and they'll oblige as long as there aren't other mitigating factors (severity of issue, your hospital overcrowded currently/can't handle your issue, etc.). That's why you should know what medical centers are closest to your house - know what you're getting into, at the least. __________________ My heart knows me better than I know myself, so I'm gonna let it do all the talkin'.

12-04-2006, 09:38 AM	#12 (permalink)
Cynthetiq Tilted Cat Head Administrator Location: Manhattan, NY	More often than not if you are in an ambulance, you aren't in the condition to pick and choose where you are going, which is what my point was. More often then not we don't have as much choice and control as we think we do especially in emergency situations. Remember that time that Quadro's father tried to kill me, the first thing my mother did was check into the status of the medical center, but that was post admission. For the most part by that time it was too late, you're exposed to infection. Luckily when I was in Long Island I did have 2 hospitals equidistant from my house. I also had the pleasure of going to both ERs and seeing the difference of how they handled patients. I did not spend any time looking at any of the infections, certifications etc, but I do know that one treated me more respectfully than the other. __________________ I don't care if you are black, white, purple, green, Chinese, Japanese, Korean, hippie, cop, bum, admin, user, English, Irish, French, Catholic, Protestant, Jewish, Buddhist, Muslim, indian, cowboy, tall, short, fat, skinny, emo, punk, mod, rocker, straight, gay, lesbian, jock, nerd, geek, Democrat, Republican, Libertarian, Independent, driver, pedestrian, or bicyclist, either you're an asshole or you're not. What's the best nation in the world? DO-NATION!

12-04-2006, 10:00 AM	#13 (permalink)
JustJess Unencapsulated Location: Kittyville	Agreed - and it's easier to be picky when you live in NYC and have a multitude to choose from. I'm not sure why this means you wouldn't want to be educated on the hospitals in your area, though - the more you know, the more likely you'll survive! __________________ My heart knows me better than I know myself, so I'm gonna let it do all the talkin'.