When Reality Does Not Meet Your Expectations—Communicating Your Concerns and Complaints
Fortunately, most hospital stays are brief, peaceful and uneventful; medical treatment proceeds as planned and patients leave the hospital healthier than when they came in. But for a growing number of patients, hospitalization creates more problems than it solves. Patients return home after experiencing doubts, concerns, and life-threatening complications. They might be dissatisfied with their diagnosis, treatment plan, or recovery recommendations, and often the origin of their doubts and conflicts can be attributed to a simple lack of communication or a misunderstanding between them and their healthcare providers.
We have all heard media reports about the dangers that arise from a serious breach in the communication process. The most notorious are the cases where one patient is mistaken for another. The unfortunate patient then goes on to have an operation he doesn't need at all, and the one who does need it goes untreated. Those are the TV-worthy stories. What patients don't hear about as often is the seemingly "harmless glitches" that, in reality, can set the stage for a breakdown in communication and the resulting endless cavalcade of errors. A recent situation involving my aunt is a perfect example of how easy it is for a series of crossed signals to impact a hospital stay in a negative way.
While hospitalized for hernia surgery, my Aunt Rose felt that she was having excessive pain, but as soon as the new shift nurse entered her room, she announced, "You're doing great. You haven't even used much pain medicine," and proceeded to take vital signs. My aunt had heard the nurse state emphatically that she was doing well, and she hesitated to disagree with her. What was particularly confusing was that she had been pushing the button to release medication frequently, yet the nurse insisted she wasn't using "much." By the time it occurred to her to say something, the nurse had already left the room. Rose never realized that the nurse could be mistaken, so she just thought that she was being hypersensitive about the pain. So she suffered in silence, assuming that the nurse could assess her condition better than she could herself.
Hours later, my aunt's daughter-in-law came to visit; Rose informed her of the earlier conversation with the nurse. The young woman looked at the pump and noticed that the numbers were lit up but not changing when Rose self-administered a dose; her mother-in-law needed, and failed to get, medication simply because the pump was not delivering it. The nurse was summoned and quickly discovered that the machine had not been reset after Rose left the recovery room.
Three things contributed to this situation:
- My aunt did not communicate what she knew to be true. She was, in fact, in pain. If Rose had simply said, "I might seem like I'm doing OK, but actually I'm not," it would have alerted the nurse that further assessment was needed. Unfortunately, you cannot always count on medicated patients to speak up, which is why having an advocate stay with the patient is invaluable.
- The nurse made erroneous assumptions about Rose's pain level without specifically asking her about it. The lesson here is for patients to speak up if their providers seem to be relying too heavily on machines or numeric values when they seem at odds with their personal experiences.
- A "glitch" in hospital procedures allowed Rose to be transferred to another unit without the pump being checked and reset.
When you observe even one glitch, you can probably assume that it has happened before and will happen again if somebody doesn't intervene and try to change it. After I asked Rose if she had issued a complaint or taken any action to prevent the problem from happening again, she seemed bewildered; surely her nurse had taken care of all that. I could understand that in my aunt's condition, just out of surgery and woozy from morphine, she might not want to take on the complaint process. But, her daughter-in-law was in perfect health and could have asked the nurse to report the incident to the proper supervisor. As happened with my aunt, though, it never came to mind. Rose could also have initiated a complaint as soon as she felt well enough, or even via a phone call after she returned home.
After an incident like this, it may seem that no harm was done so it's fine to let it go, but we all have to become more altruistic about these occurrences. It is not enough to breathe a sigh of relief when you get home and say, "Well, that wasn't so bad. At least they didn't cut off the wrong leg or kill me." Think about it though: in many other situations, we think nothing of warning others about life's pitfalls. Consider the number of occasions that you take the time to spare friends and neighbors mere inconveniences, like telling them to put their garbage cans out on time or avoid certain roads because of traffic congestion. Think how important it is to you to be sure that any danger you have identified or lived through is one that you can spare your loved ones. Somehow in hospital situations we have not cultivated this same mindset.
To make effective complaints, you have to first know what's gone wrong, and there are basically two ways for you to find out. One is that you experience an adverse event personally and you have an idea what is causing it. Or, two, someone who works at the hospital is honest enough to tell you something went wrong. All hospitals have their own internal administrative systems to deal with patient problems, but, of course, a patient must rely on a staff member to be told that there is a problem or figure out on her own that something is amiss. What you must realize is that whatever incident – big or small – that you are going through, it may be only the tip of the iceberg. The true extent of the problem could be far greater than you know. It could, in fact, be system-wide. Some hospitals are implementing policies to inform patients of errors or of iatrogenic injury (injury caused by doctors or medical treatment), but at this time there is no comprehensive, universally applied federal law or regulation stating that every institution must inform patients when they have been the recipients of faulty medical treatment.
As a result, for decades, patients have been kept in the dark about injuries caused by the very hospital they put their hope and faith in. People usually have an inkling when something is wrong because they are in excessive pain, their recovery is prolonged, or their infection won't go away. Even if the risk manager or hospital administrator is "looking into" their situation, patients cannot assume that the institution is motivated only by concern for the individual's welfare. Hospitals have been known to keep pertinent information away from patients to avoid trouble. Remember that they employ lawyers and other risk management personnel to handle potentially litigious patients. If you cause a stir, they might mount a defense, advise their staff on how to respond to your inquiries cautiously, and quietly review your medical record as a way of heading trouble off at the pass. I am not saying that the administration is "against you," but it certainly views you as someone they need to protect themselves against if it looks like you are voicing a complaint to people who can sanction them.
This method of doing business has left patients unaware of the many mechanisms in place, both inside and outside the hospital walls, to assist them when there is an unfortunate incident.
Upon admission to the hospital, information should be readily provided explaining how to contact the patient relations department or what to do if you experience a problem. When you register, be sure that the admitting office provides you with information about the hospital's system for dealing with concerns or complaints. If problems arise that are not resolved by dealing directly with your treating physician or your nurse, you need to be aware of the other individuals and agencies with the authority to intervene on your behalf.
The individuals and groups are:
- Charge Nurses and Nurse Managers
- Patient Relations Specialists/Patient Advocates/Ombudsman
- Social Services
- Infection Control Specialist
- Department Heads/Service Heads
- Hospital Administration
- Medical Center Director/Chief Operating Officer (COO)
- Hospital Licensing and Certification
- The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- Medical Boards
- The Media
There is a hierarchy of sorts when deciding whom to take a complaint to. The logical starting point is always your nurse and treating physician. But if you cannot reach a solution that is both timely and acceptable, start working your way through the above list. The Charge Nurse or Patient Relations Specialist will be able to handle a large percentage of patient complaints. Social Services and Infection Control Specialists may be able to handle specific issues regarding communication glitches with your caregivers or investigate the source of your infection. The head of a particular hospital department or medical "service" needs to be consulted if you have an issue with your physician or his treatment plan that cannot be resolved by talking to your doctor directly. For serious complaints such as the occurrence of life-threatening complications, "systems errors," or care that seems truly negligent or substandard, the hospital administration and possibly the COO need to be contacted. Situations involving patient safety issues, potential violations of current medical standards of care, and physician misconduct can be reported to hospital licensing boards, medical boards or to the Joint Commission. The media is the last, yet often the most powerful, resource to resort to.
The advice and actions listed above represent only a fraction of the resources available to advocates to help them ensure that patients arrive home safe. They are realistic, achievable and could very well save your life or the life of someone you love.