Save Your Life or The Life of a Loved One: Ask These Questions
You Cannot Afford to Be Passive in Your Health Care: Here Is Why and How You Can Be Effective
Seven and one half years ago, I drove through the rain on a highway heading into Raleigh. It wasn't a bad rain and I was driving the JEEP that my daughter convinced me to get because those types of cars were safer. That isn't true, most turn over much more than cars.
I put on my turn signal and started to move into the left lane, when a noticed a little red car coming up on me, fast, and I adjusted to get back into the right lane to avoid a collision, which I avoided.
However, as the car made its way back to the right lane, it suddenly was hard to control. Ignoring all the counter indicated, but correct, information I knew about skids, I tried to turn right. The last thing I remember was thinking, "Boy, these things are really heavy." which they are when you are trying to keep them on the road.
The next thing I remember is being in the car with my head out the window with a man's hands hold my neck very still and a woman's voice soothingly saying, "Don't be afraid". I couldn't imagine what I had to be afraid of, but I could see peripherally, a lot of people. I assumed they were there to pick my Jeep out of the ditch so I could drive home.
Imagine my surprise when the 'Jaws of Life' tore open the roof and lifted me out where I was secured to a board so heinous that it would have been popular at the Inquisition. I was taken to the hospital where I laid for hours on that thing until the x-rays were done and the Radiologist cleared me.
I although I was stiff and sore I did a little jig to show people, my friend and myself that I was fine. My neck was stiff so I spent the next week stretching it.
A week later I took the x-rays into my chiropractor because I thought it would be a great time for an adjustment. He was pleased that they hadn't put me in a neck brace and that I was exercising. Until he saw the rather large chunk that was missing from C2, a rather important vertebrae whose injury often or usually leads to quadropaligic states or death. He handed me the neck brace that he had laying around (I was his second patient in his career to get one) and sent me back to the ER.
Never get an X-Ray without looking at the pictures, they will let you do it and you will see things that may have been missed. My injury was a chunk, not a hairline fracture. I have to believe I would have wondered what it was had I seen it.
My Story Ended Well, But I Wanted a Good Ending for Others
The break did not kill or paralyze me, nor did the week of doing what I shouldn't have done. The neurosurgeon didn't do surgery, but did put me in a most unforgiving neck brace for 4 months. But I was ok.
So my next concern was "Who was this radiologist? Was he incompetent or an alcoholic or most importantly would he do this to someone else who wouldn't be as blessed or lucky as I was?".
I felt a duty to find out. I wrote him a letter stating first that I was ok and had no plans to sue, but that I had to assess that he was competent to diagnose other patients. Arrogant of me? Perhaps, but I thought it was my duty.
He was a member of a large practice, the owners of which did their best to keep me away from him, which only made me more determined. I finally wrote and said that if I couldn't speak with him, I would have to write to his licensing board to have them find out what I needed to know.
He came to my house, something I found out, that he had wanted to do from the beginning. He was a lovely man and I can only imagine the distress he felt when he saw my X-rays after I wrote.
We talked nearly two hours, he was in no hurry to leave or intimidate me (his practice had wanted him to bring others, I am guessing for that very reason).
He told me that sometimes the wrong dictation gets put with the wrong X-ray and he had hoped that was the case, but after looking into it, he knew that didn't happen. That did nothing for my confidence in the hospitals, but I admired his candor.
By the time we were through I had used my considerable and professional assessment skills to decide that he was a good doctor, not a user of drugs or alcohol on the job and had just made a mistake, something we all do.
BTW, it was he who told me that I should always insist on looking at my own X-rays, something I have done since. I looked at all of my neck follow-ups, all my mammograms and the bone scan. I ask the techs to explain to me what we were seeing.
This is something you can all do.
Always Look At Any X-Rays and Discuss Any Diagnosis With the Questions Below.
It Is Your Right and Responsibility to View Your Own Xrays
Learn How Your Doctor Thinks, Communicate Better, Save Your Life
Below is the story of my father and my struggles to get him the right care in the hospital. There are three examples of problems and all three were the result of doctors who made assumptions based on his age without bothering to ask anything else.
Dr. Groopman has also written an article, a synopsis of the book for the September/October issue of the AARP magazine.
I have gotten some of the information for this lens from that. The article is titled: "Why Doctors Make Mistakes".
"Most errors are due to mistakes in the doctor's thinking."
This is about saving your life, but there is also a business opportunity here.
When Doctors Don't Collect Enough Information
Ten years ago my parents lived in a guest house in my back yard. It worked out great, as we all had lots of privacy, well I did, but they were close and on the rare occasion that Dad needed me to help with Mom, I was there.
Dad had to go to the hospital for a few days, which meant that I would have stayed home with Mom, but she ended up there also.
When day when I was there Dad was so upset. A doctor had set them up to go to an assisted living institution. Dad learned about this from the social worker who had come to put them in a place.
The doctor had seen an 81 year old man taking care of an 81 year old woman and diagnosed that he couldn't do it. Without gathering any more information, he made a diagnosis and decision and set something in motion.
Had he asked questions beyond what he saw in front of him he would have found out that:
1. Dad was in good enough shape that he was doing 90% of the work on my kitchen remodel.
2. Their daughter lived a mere 50 feet away, providing more assistance than most assisted living places did.
3. Although they were frugal and successful at their business, 18 months in an assisted living place would have made them broke and homeless.
I think that doctor meant well, but he just didn't look beyond his own nose and certainly didn't find out what he needed to know.
This may not have been an immediate life threatening situation, but I guarantee you that had they gone to an 'old folks home' it would have taken years off their lives, certainly Dad's who at 91 lives with me and is still taking care of himself.
Lesson: Ask Question #3
"Is there anything in my history, physical examination, laboratory findings, or other tests that seems not to fit with your working diagnosis?
"He's Just Confused, 'They' Get That Way"
A couple of years later I got an hysterical call from Mom. Dad was curled up in the middle of the floor and she was, rightfully scared. It turned out that he had aspiration pneumonia, spent a week in the hospital and another in rehab learning to swallow. For months he had to put an icky 'thickener' is all his food and drink to keep it from going into his lungs.
However, the day after he went to the hospital I got the call that he was ready to come home. Great!
I turned the corner of the corridor expecting to find him dressed and ready to go. What I found was him in an open hospital gown, tied to a chair and floridly hallucinating. Of course, my first reaction was what you would expect in someone finding a healthy and mentally sharp parent suddenly in such a condition. And while I understood that the nurses couldn't spend the that much time keeping him safe, this was my dad they had tied up.
But those were personal issues, the most important thing was that there is no way he was 'fine and ready to go home'.
I protested to the doctor. He explained that 'they' get confused in the hospital and it was really better for him to go home.
With all my diplomatic best I responded that
1. 2 days earlier Dad was more cogent and intelligent than the doctor.
2. He had been in that hospital 3 times in the last year and my mom once, thus it was familiar territory.
3. He wasn't confused, he was hallucinating and the doctor should know that those are two different things.
I had them untie Dad, guaranteeing that I would watch him and spent the rest of the day battling the doctor who insisted that Dad could go home. In fact, he said that he would be better off there and that I was harming him by wanting him in the hospital.
The doctor was wearing me down. I finally called my sister-in-law and asked for help. She is a nurse who was in charge of a hospital so she knew how to handle doctors. She is also a proud Cherokee woman who never raises her voice, but you don't want to mess with her. She spoke to him from 3000 miles away and I have to confess that by that time I enjoyed watching the blood drain from his face. He got off the phone and said that Dad was staying.
The next day the head hospitalist reassured me that Dad would have been ok at home with antibiotics. He didn't quite pat my head. I pointed to the sign on Dad's door that said "Nothing by Mouth" and asked the speechless doctor, "and the antibiotics would have fed him intraveniously?"
A really sad thing is that while I am a medical professional and used to recognizing and dealing with manipulation, I woke up that night thinking, "What if the doctor was right and I hurt Dad by keeping him in the hospital?" And of course, I had my sister in law.
People need an advocate when they or someone they love is in the hospital.
Lesson: Ask Question #1
"What else could it be?"
Doctors Tend to Not Look Beyond The First Thought
A year or two later, Dad was out driving with me. He still had a license and a car then, but I was driving.
He kind of laughed and said, "I see a man on the sidewalk wearing an Indian blanket, is that really there".
"No", I replied, "and the only other time you hallucinated, you had serious pneumonia". I talked him into going to the ER where sure enough he had the beginnings of pneumonia again. They gave him the anti-biotic and wanted to keep him. We argued but they really wanted 'just one night'. I went back to get him the next day and was told they wanted one more day to see how he reacted to the new medicated.
Now, I have always thought that they have him on too many meds, so I asked what it was. When I heard the word, Zyprexa, an anti psychotic, to say I hit the roof is mild. We were on the fifth floor, but I think the people in the lobby heard an echo.
The nurse looked it up and of course, is was not just unnecessary, but was bad for people with high blood pressure. Dad said, "I wondered why they gave me a higher dose of bp medicine this morning". Some doctors were already concerned that he was on too much, but now he was given an unnecessary med that meant he needed even more bp meds.
The reason for this is that the doctor didn't ask the question, "What else might be going on?" They saw hallucinations, and jumped to the conclusion that an anti-psychotic was the answer, even though they are very toxic and only to be used for those who need them.
So one time they took the side effects of pneumonia and assumed it was just a confused old man and another time that he was psychotic. They were wrong both times.
Lesson: Ask Question #2
"Could two things be going on to explain my symptoms?"
Look At These Videos and Ask Yourself...
These videos of my 91 year old dad don't have anything to do with the topic, but they are very important to the issue. Look at one of them or all and remember that this is the man that 6 years earlier doctors thought was senile or psychotic, ignoring that his hallucinations were the result of a severe pnumonia and not old age or mental illness.
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"Why Doctors Make Mistakes"
It comes down to not listening to you and making assumptions. Make sure you are heard and read this to make sure you ask the right questions.
- How Doctors Think by Dr Groopman
This article, an introduction to Dr. Groopman's book, talks about the three issues that could have killed by Dad. He helped me formulate more clearly what was going on so that I was able to present them to you.
There Is a Lot of Really Good Health Care, But You Have to Be An Active Part of It
Really there is.
When Dad was 85 he went in for a triple bi-pass that turned out to be quintuple. They did a great job in surgery and caring for him in the hospital.
He has macula degeneration. He has an eye doctor who keeps a close 'eye on him', which is why he can still see 10 years after the diagnosis.
There is a lot of good health care, there are lots of great doctors.
But you have to know what questions to ask, based on how they are trained to think.
Raleigh, NC: The Best Place to Live
Raleigh, Durham and Chapel Hill, are always on the "Best Places to Live" lists. There are many reasons, but they always mention the best health care in the country.
If we need to know these things here, with such high ranking medical care, then everyone needs to know them.
People Need Help
I Was Fortunate With My Dad
1. I have experience in mental health
2. I had my sister-in-law
3. I lived in the same town.
There are so many people who don't have a clue what to do or ask, who don't have family help an/or who live far away.
I think we need people who could help families protect loved ones when they are in the hospital, and there are lots of people who would pay for that important service.
The New Library
Save money on books, save wall space and you can take your whole library on vacation!
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Or comments on the lens, stars appreciated!