August 16, 2012

Think Your Hospital Is Looking Out for You?

If you think when you are in the hospital that the hospital is looking out for you, you are in the minority. Day after day, we see news of people that have stories to tell that are not showing hospitals in a good light. We hear of friends or relatives of friends that have died because of medication errors, errors in medical judgment, and errors in operations performed on the wrong patient. It will soon be apparent to even the most careful of patients that they will need a patient advocate if they are to be admitted to a hospital.

Even then, patient advocates will have a difficult time. Hospitals do not like patient advocates and do their best to work around them or even conceal what is happening. Yes, several decades ago, there were accidents and errors, but not at the ratio of today. We had doctors that spent time with patients and checked in regularly. We had nurses that knew what to do and communicated with the patient’s doctor(s) and the patients. They would alert doctors of changes in a patient's condition and test results.

Then came larger hospitals and more lawsuits. To protect their profit margin, nurses were marginalized, doctors restricted in their duties by the hospitals. Patients in the hospitals are being seen less often and not by their own physician. Is it any wonder there are more errors and improper medications given? Allergies are not checked and communications are limited.

This article in a Diabetic Connect newsletter says a lot and lays out many of the problems we encounter as people with diabetes. This from the article needs to be quoted, “The problem with hospitals is that they standardize care much more than they individualize care. This is due in large part to the huge volume of patients they service, and the need for general protocols. General protocols, however, do not work all the time for patients with diabetes. If you have never used insulin and the plan is to give you insulin in the hospital, work with your health care team to understand what to expect. I would advise family members to carry blood glucose meters with them and have them available for a quick check if necessary so that you can alert the hospital of a potential problem with high or low blood sugars.”

These general protocols can make it impossible to manage blood glucose levels in the range that you are accustomed to. Most hospitals do not want you to use your pump if you use one. They even discourage continuous glucose monitors. Occasionally you will find a hospital that will allow the patient to manage their diabetes while in the hospital, but this is rare and must be decided upon before admission. I would even suggest getting it in writing.

Another issue the article raises that I can appreciate is some hospitals are giving rapid-acting insulin after a meal. This surprisingly allows the patient to not eat the food that you will be served and/or eat what you think will be sufficient for your needs. Then the amount of insulin can be adjusted for the food eaten. Most hospital food is not very enticing and is loaded with carbohydrates. This is because of the dietitian mandate that people with diabetes should have 60 grams of carbohydrates at every meal.

I do appreciate the author's comment and I quote, “I do not in any way want this to scare you, but rather to encourage you to be an active participant in your healthcare. Any and all family members and loved ones should be involved as well.”

Hospitals need to learn how to treat people with diabetes. This will mean every family member will need to be on board and maybe even a diabetes patient advocate. If the patient is going to be incapable for any period of time and a family member is unable to be present, even a medical power of attorney will get their attention as long as the persons present are listed on the document. Even then, many hospitals will try to circumvent this document.

If you are the patient, make sure that you dot all “I's” and cross all “T's” and that your wishes are known, if possible, before admission to the hospital. Remember that the hospital protocols may not be in your best interests for diabetes management. Hospitals have protocols that are in their interest to protect their profit margin and prevent lawsuits.

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