As the chief executive of a major medical center, I have reviewed dozens of cases in which patients knew something was wrong with their care but were too polite, too uncomfortable or too intimidated to speak up.
Example: One woman didn’t say anything when she was called by the wrong name. She just went along — and wound up having extensive tests that were intended for another patient.
No serious harm was done in this case, but others aren’t so lucky. I’ve seen people needlessly suffer severe pain because they didn’t want to question their doctor’s judgment… or risk a serious infection because they felt that it was rude to tell someone to wash his/her hands.
It’s normal to feel intimidated in the authoritarian environment of a doctor’s office or a medical center — but it’s better to be tough. Studies show that so-called difficult patients, ones who demand the highest level of care, recover more quickly and with fewer complications than those who are passive.
Some common “sticky” situations — and how to respond…
You might feel rude telling someone to wash his hands. Do it anyway. Every year, nearly two million infections are spread in hospitals. The Centers for Disease Control and Prevention (CDC) estimates that this number could be reduced by as much as 70% if health-care workers would consistently wash their hands before and after treating each patient.
Reducing infection, particularly from potentially deadly organisms such as methicillin-resistant Staphylococcus aureus (MRSA), is more important than not saying anything because you’re embarrassed. Don’t let anyone in the hospital touch you until…
You’ve seen him wash his hands, either in a sink or with an alcohol-based gel sanitizer. You can say something like, “I’m sorry, but I’m really afraid of infections. Would you mind washing your hands before we start?”
You’ve seen him wash before he puts on gloves. The gloves won’t protect you if they’re contaminated from unwashed hands.
He has wiped and sanitized instruments that will touch you, including blood pressure cuffs and stethoscopes. Hospital staff use alcohol pads or cleaning cloths with disinfectants, such as ammonia, to clean equipment.
You are never required to continue a treatment or procedure that’s going badly.
Examples: A nurse might fail to properly insert an intravenous (IV) needle after multiple attempts… or a resident might have a hard time doing a spinal tap.
When someone has a needle in your back, it might not feel like the best time to complain, but it’s your right to do so… to ask someone else to take over… or even to stop the procedure.
At teaching hospitals, many procedures are done by residents. If a procedure or treatment is taking too long or causing too much pain, ask for a more experienced attending physician to take over. You could say something like, “This seems to be taking too long. I would appreciate having someone with more experience try.” If the staff argues — or, worse, ignores you — ask to speak to a nursing supervisor.
Helpful: Ask a friend or family member to be present during procedures. Patients understandably are reluctant to challenge their health-care team. An advocate, however, is more dispassionate and can watch out for your best interests. He/she might say something like, “I think she’s had enough. We need to take a break for a moment.”
Suppose that you’ve been having headaches. Your doctor might make the diagnosis of migraines and prescribe a strong prescription drug. That might be the correct decision — but what if later you wonder if the headaches are linked to something in your diet and that the medication might not be necessary?
Don’t be silent. The average patient knows more about his symptoms than the doctor. Most doctors welcome additional information, even when that information changes the original hypothesis. In this case, reporting a food sensitivity could be an important part of your treatment because migraines often are linked to dietary factors.
Important: If your doctor seems threatened by your questions or dismisses your ideas out of hand, get another doctor.
It’s common for patients to needlessly suffer postsurgical pain because they don’t want to seem like complainers or because they’re afraid that their doctors will suspect they’re drug abusers, but adequate pain control is critical. Patients who experience little or no pain are more ambulatory, less likely to get pneumonia, have a lower risk for blood clots and leave the hospital, on average, one to two days sooner than those whose pain is managed poorly.
There are no tests that can accurately gauge a patient’s pain, so self-reports are critical. Addiction is rare when drugs are used for temporary pain relief — and doctors know this. What to do…
Never assume that your level of pain is normal. If you think the pain is intolerable, it needs to be treated. Make sure that your pain is taken seriously.
Request a pain assessment. Pain is considered a vital sign, along with factors such as blood pressure, pulse and temperature. As soon as you notice pain, ask for a formal assessment. You’ll probably be asked to rate your pain on a numeric scale, with zero indicating no pain and 10 indicating the worst pain imaginable. Most patients can attain levels of two or below with the right medication.
If you need a higher dose, or more frequent dosing, say so. Your doctor will understand if you say that the pain treatment isn’t working. Everyone responds to painkillers differently.
Recommended: Patient-controlled analgesia (PCA). These devices deliver small regular doses of medication, usually intravenously, when you push a button. They now are the preferred method for controlling postsurgical pain.
A hospital doctor sometimes will poke his head in your doorway, ask how you’re doing and then rush off before you have a chance to discuss concerns.
Doorway visits are always inappropriate. If you’re nervous about confronting the doctor directly — or he never sticks around long enough for you to say anything — you might keep a notebook by your bedside. Write down your questions and concerns. Then, when the doctor makes his rounds, hold up the notebook and say something like, “I’m glad you’re here. I have just a few issues that I’ve written down. I’d like to go through them with you.”
Don’t be embarrassed to discuss financial issues with your doctor or the hospital, particularly if you don’t have insurance. Negotiating fees and payment schedules is routine.
Example: Suppose that you have recently lost your job and health insurance. Bring it up the next time you see your doctor. Say something like, “I want to make sure that I get the best care, but I don’t have health insurance right now. Cost is important, so I would be grateful if we could discuss it.”
Doctors often reduce fees for patients who don’t have insurance. They also can reduce costs in other ways, such as prescribing generic rather than brand-name drugs, ordering only essential tests and scheduling telephone follow-ups rather than office visits.
Exception: Health-care fees established by government insurance plans may not be negotiable. It’s illegal, for example, for your doctor to waive Medicare copayments or deductibles.
