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America’s healthcare system is under serious assault. Escalating costs associated with pharmaceutical products, reduced accessibility to experienced nurses and physicians and the sensitive political issue of universal access for every American are all issues crippling the state of today’s healthcare system.
In the new book, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive, author Martine Ehrenclou addresses the real-life concerns all Americans should reflect upon before admission into a hospital. “Is this institution a place that will look after my welfare or the welfare of my loved one or do I face the serious contingency of complications or, worse-case scenario, death?
BlackGospel.com spoke with the author to address such questions. And much like her book, Ehrenclou provided insightful, provocative and personalized perspectives to keep any reader’s attention and, hopefully, save a life in the process.
Christopher Heron: Martine, I'd love to start with the title for your book - Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive. That's a title to grab your attention! What inspired you to tag your book with this hyperbolic title?
Martine Ehrenclou: Even though the title of my book, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive, sounds dramatic, there is truth to it. The title is supposed to grab your attention. However, nearly a quarter of a million hospitalized patients died because of preventable medical errors (The Fifth Annual Health Grades Patient Safety in American Hospitals Study, 2008) and 100,000 people die each year due to hospital-acquired diseases, according to the Wall Street Journal. Those are pretty dramatic reports.
Risk of death due to a hospital stay is not just hyperbole. All of the doctors and nurses I interviewed considered a hospital stay to be extremely precarious and in fact potentially life threatening. One physician even said, "Stay out of hospitals if you can." But there is something everyone can do immediately to survive a hospital stay---enlist a loved one to act as your advocate and ask them to get proactively involved in your hospital care.
CH: The experience your loved ones had to undergo in the health care system is both telling and tragic....but is it a common occurrence? Are most people at risk when they or their loved ones are admitted into a hospital? Or did you experience a uniquely tragic sequence of events? And how do we, as uninformed patients, decipher whether we indeed are at risk?
ME: Sadly, the experiences with my family member's hospitalizations are in fact the norm. The length of my godmother's (7 months) and mother's (5 months) hospital stays are very unusual. Initially, I interviewed fifty family members who all reported the same exact challenges and pitfalls as what I had experienced with my mother and godmother. Over one hundred people have come forward since those initial interviews and have recounted stories that all have the same qualities----people reported immense frustration with the hospital system, medical errors, medication mistakes, patient name mistakes, nurses not responding to the call button and doctors not calling them back.
If more
than one doctor was involved in a patient's case, most reported that "there was
no captain of the ship." One nurse told me about a patient who was scheduled to
be discharged by the Intern one morning. She didn't think that was right and
called the Attending physician. The Attending said that the patient was supposed
to have surgery that day—talk about the right hand not knowing what the left
hand is doing!
Several people explained that their loved ones were admitted into hospitals for
minor or simple procedures and then didn't come out alive because of some form
of medical error during surgery or because of an infectious disease caught in
the hospital. Others relayed stories of patient neglect.
Everyone who enters the hospital is at risk of medical errors, medication mistakes, contracting hospital-acquired infectious diseases (MRSA and pneumonia among the most virulent), fatal falls, and more. You've heard about the Dennis Quaid twins and their life threatening medication error in a well respected Los Angeles hospital. Numerous cases just like this one have occurred before and since. The Institute of Medicine states that a hospitalized patient is subjected to at least one medication error a day.
You asked how we decipher if we are at risk. We are all at risk. But the risk increases if you are of a minority or ethnic group, if you have no health insurance, if you live in a rural area, if you have multiple medical issues, if you are admitted to an insufficiently funded hospital, if your state does not have a nurse-to-patient ratio law, and more.
We are all at risk. This hospital crisis crosses lines of race, ethnicity, religion, gender and age. However, certain minorities suffer more pronounced effects. Every physician and nurse I interviewed stated this: "You must have someone with you in the hospital at all times---hospitals are in crisis."
CH: 2008 is an election year. One of the issues of concern to most Americans is accessibility to good, safe and affordable health care or the possibility of universal healthcare for all Americans. As you see it, what questions should Americans ask themselves as it relates to healthcare and our health system, before casting a vote for one of the candidates?
ME: Health care is on all of our minds in response to the presidential election. We all want and deserve affordable and safe health care. The questions Americans must ask themselves when considering a presidential candidate are:
1. Who is going to make it a top priority to implement a more successful system for healthcare and who will make a commitment to monitor it for quality?
2. Who is concerned with hospital-acquired disease prevention?
3. Who is concerned with requiring all states to implement laws for hospital error reporting? Who is willing to enforce those laws once they are implemented?
4. Who is concerned with patient safety?
5. And which candidate is more likely to stop insurance companies from dictating a patient's hospital care and overriding a physician's medical opinion?
Go to each candidate's website and find their positions on health care. Obama and McCain have different positions on these issues.
CH: Your book - Critical Conditions - frequently addresses the burden and stress of our current hospitals and the consequent risks and dangers that accompany this unacceptable ratio of patients to healthcare workers. Is this a new problem or have we, as Americans, always faced this problem? And what exactly is at risk when there are too many patients or too few nurses and doctors?
ME: Because of the Baby Boomer generation, we have more people with multiple medical issues that require hospitalization. ABC World News Tonight reported that patients in hospitals today are sicker than 20 years ago. Hospitals now admit those who need care the most. And now there are fewer nurses available to hospitals. Because there is a drastic, nationwide nursing shortage, patients are more at risk for complications, medical errors and potentially life threatening circumstances. Mistakes are made because we are human. The more patients for nurses to care for, the margin for medical error goes up.
Just to really make you crazy, let me tell you about my godmother in the ICU. There is one nurse to two patients in the ICU. That’s a pretty decent ratio, right? Well, how is it then that she developed a bedsore the size of a football because the nurse wasn't turning her enough? As soon as I discovered it, I monitored how often her nurse turned her.
You really go into the hospital for nursing care. The primary nurse is your life line. If your primary nurse is overworked or has too many patients to care for and too much paperwork to complete for each patient, your care can be compromised. Not because nurses don't care—they do, very much so. But the demands on nurses have increased.
Certain states (California is one of them) require a nurse-to-patient ratio of 1:5. That means one nurse to five patients. Other states do not have that law. In some states, a nurse can be caring for as many as ten patients. If only I could turn back the clock on my mother's hospitalization, I would have created a family advocate team to watch and support her medical care every minute of every day (when I had to travel back to California) and would have hired a sitter to monitor her care at night.
CH: In your study of professional healthcare in hospitals around America, did you find that the level of care differed from state to state? Was the economics of a county a factor? Was race, gender or age a variable on the probability of getting out of a hospital alive?
ME: According to my research and interviews with physicians, registered nurses and other hospital staff, the level of hospital care varies based on the following:
1. Nurse-to-patient ratios. This depends on each state's requirements.
2. Rural vs. metropolitan hospitals. Physicians gravitate to urban areas, hence the physician shortage in rural areas.
3. If the doctors involved are board-certified in their specialties and are affiliated with a medical school. Many physicians I interviewed strongly emphasized this, while others disagreed.
4. Properly funded hospitals. Remember King Drew Hospital in Los Angeles? That was a very sad state of affairs. The more trouble that hospital got into, the more negligence and medical errors that occurred—it was a snowball effect.
You asked if race or gender plays a part in the quality of hospital care. This is really a loaded question, Christopher! According to a study from The Kaiser Family Foundation, January, 2007, there is compelling evidence of racial and ethnic differences in health insurance coverage, access to primary care and treatment for specific medical conditions. "Persons from low-income families and communities of color are at greater risk of being uninsured than their counterparts, and thus more likely to experience disparities in healthcare and quality of care."
What I drew from my research is that health insurance is key to timely healthcare. Approximately 46 million Americans—half of whom are racial/ethnic minority Americans— have no health insurance coverage.
All the more reason to have a family member or good friend act as an advocate to monitor the quality of care, make the most of the relationship with the primary nurse, and be present with the patient as much as possible.
Personally, I suspect that age may also affect how medical care is administered. This is my own personal observation—I have not researched studies to support this. I see some elderly people with multiple medical issues who have too few people to help them. I'll give you an example.
I recently flew to Florida to take care of my eighty year-old uncle who had endured multiple hospitalizations, a staph infection from surgery and total neglect in a rehab facility. I arrived in Miami and he told me that his infectious diseases doctor wouldn't call him back after he had called three times. My uncle was concerned that he still had the staph infection. This is a reasonable concern. We called the office and also faxed the doctor. Still no reply and it was Friday before a holiday weekend.
With no appointment, I drove him to the physician's office and asked that he be seen. My uncle was seen, his blood tests were explained, and his knee examined. The results of the staph infection were negative. Now, that would have taken that physician 30 seconds to call my uncle and explain the same thing. But I suspect because I'm a family member, I am assertive, and I was with my uncle, we got more attention. My uncle is convinced of this himself. My uncle was dismissed by that doctor. Was it because he was 80 years old? Was it because he was worried that the staph infection (potentially life threatening) had come back and he had bothered the office? Was the doctor simply overwhelmed by a demanding patient load and had forgotten to call back? Who knows? I do know that my uncle's doctor treated him better when I was there. He paid attention.
I suspect there are many older Americans who, like my uncle, are not given proper attention or respect. I find this idea difficult to stomach. Hence my belief that all older Americans need loved ones with them to help advocate for them.
CH: In summary Ms. Ehrenclou, could you please share with us 5 critical lessons the reader will learn once they’ve read Critical Conditions, which will benefit both the reader and their extended family?
ME: The reader will learn the following points from my book:
1. How to be your hospitalized loved one's best advocate.
2. How to prevent medical errors, medication mistakes, the spread of hospital-acquired infectious diseases, fatal falls and more.
3. How to reach the doctor when you really need them---every time.
4. How to maximize the relationship with the patient's primary nurse to benefit patient care.
5. How to navigate the hospital with confidence.CH: Finally, as a Christian woman who's survived your own ordeal, what is the mission and vision you have for anyone who takes the time to read your book?
ME: As a Christian woman, I am committed to the belief that we care for others in need, especially for those who cannot care for themselves. Hospitalized patients cannot monitor their own care or advocate for themselves—they are recovering.
My hope is that through the information in my book, people will realize just how important it is to be involved in a loved one's hospital care. I also hope I have been able to empower readers to brave the foreign world of hospitals and to not be intimidated by what is a most unpleasant place, or by the physicians and nurses they must confront. I do believe readers will get inspired to become proactively involved after reading my book and will know exactly what to do and how to do it in the face of a loved one's hospitalization.
For more
information and to order the book, Critical Conditions, visit the official site
at
www.criticalconditions.com.
