It’s National Nurses Appreciation Week. Today we have a guest post from novelist Carre Armstrong Gardner who in addition to writing, is also a nurse. In this guest post, Carre provides some practical advice that nurses wish their patients knew.
With insurance companies calling the shots on reimbursement and dictating how long a physician spends with each patient, doctors have never been busier. A primary care provider or specialist sees between 15 and 50 patients every day. Office visits can feel rushed. Details fall through cracks. In spite of everyone’s best intentions, you may not be getting the best care you could. Talking to a nurse can help. Because we have more time to spend with patients, we often see patterns that doctors miss—things we wish our patients knew. I asked nurses across a spectrum of health care disciplines the question, “If there were one thing you could tell patients, what would it be?” Here are their top five answers:
- Everyone thinks their doctor is the best.
Lynn H. needed her gall bladder out. “My surgeon is the best,” she assured her sister Kaitlyn, who is a nurse, over lunch. “Everyone says he’s the guy to go to.” A year and three hospitalizations later, Lynn is still dealing with complications of what should have been a straightforward surgery. Is this her surgeon’s fault? Not necessarily. But it does raise the question: How do you really know your doctor is good? The truth is that when most people say their doctor is “good,” this only means they like their doctor. He’s personable, or she seems professional. But when considering a provider, there is objective data you should be considering as well. The National Committee for Quality Assurance (ncqa.org) is an organization that measures, analyzes, and seeks to improve the way providers meet certain quality standards and performance measures. The Health Care Incentives Improvement Institute’s Bridges to Excellence (hci3.org) is another program that identifies and offers incentives to health care providers who meet certain standards of excellence. Both publish data about how providers measure up. Recently I looked up my own PCP’s ratings and was surprised by what I discovered. His numbers weren’t as high as others in my city. Looks like it’s time to take my colleagues’ advice and do a little informed shopping around.
- Tell us everything, even the embarrassing stuff.
Hedging information about your health could have serious implications. The nurses I spoke with who take health histories from patients about to undergo surgery said they routinely find that men who take drugs for erectile dysfunction leave them off their list of medications. Why? Because they’re embarrassed to tell a female nurse or because they don’t think it’s important. But if you’ve taken a phosphodiesterase inhibitor like Viagra (sildenafil) or Cialis (tadalafil) up to three days before your surgery, and you develop postoperative chest pain, and we give you nitroglycerin, it could kill you. And we can’t know you’re taking these drugs unless you’ve included them in your medication history. We also need to know how much you really drink on a daily basis. The standard “two drinks a day”—the amount heavy drinkers most often report—won’t give us a heads-up about what’s happening if you start to detox in the hospital. Alcohol withdrawal seizures can kill you. There are medications we can give you to prevent them, but first we have to know the truth about your drinking history. And now is no time to fudge the truth about your weight, either: it’s the guideline our hospital pharmacy uses to make sure you’re getting the proper dose of medications. So set your embarrassment aside for now and keep yourself safe.
- Your doctor should be addressing your weight.
This answer came from nurses who work in primary care practices. Studies are conclusive: losing weight is the single most significant factor in managing type 2 diabetes, high blood pressure, and obstructive sleep apnea. If you’re taking medication or using a CPAP machine for any of those diseases and your doctor is not taking you to task about being overweight, then she is not doing her job. Of course, physicians can’t force patients to lose weight. And anyone who’s fought the discouraging battle of the bulge knows that taking off extra inches is easier said than done. But you don’t have to boil the ocean: losing just 10 pounds can significantly improve your health and decrease the amount of medication you need. Less medication means fewer side effects, and it makes for happier patients and providers.
- Advocate for yourself or find someone who can.
When it comes to health care, you have to advocate for yourself. A good place to start is by knowing your own health history. Make a list of all your medications, including dosages, and all past surgeries and hospitalizations, and carry it in your wallet. Think ahead about what you will say and do if a provider recommends something you disagree with or don’t feel you know enough about. Many older patients, raised in an era when good manners dictated that they not question authority figures like physicians, can be reluctant to object to anything their doctor suggests. Hospital providers almost all have stories of patients who experienced chest pain but didn’t tell anyone until hours later because they didn’t want to bother the nurses. When you’re ill or in the hospital, it can be hard to speak up for yourself or to question providers. At times like this, it’s helpful to have another person present, someone who doesn’t feel the same compunction over raising concerns about your care. Plan to bring a trusted spouse or partner, adult sibling, or child with you to your next appointment, or to have them present in the hospital when the doctor makes rounds. Your advocate can ask questions you might be uncomfortable raising. They can request information you feel you may not be getting and can explore options and alternatives with your doctors and nurses on your behalf.
- Don’t let your child visit Grandma in the hospital.
Few things raise a hospital nurse’s blood pressure like seeing a small child rolling around on the floor of a patient’s room. In spite of our excellent housekeepers with their phalanx of bactericidal cleaning products, hospitals are still not good places for children to visit. MRSA, VRE, and CRE are a few of the multidrug-resistant organisms, or “superbugs,” that people can pick up in hospitals. These bacteria, which respond to very few antibiotics, can cause serious health problems. In the very young, the very old, and the debilitated, they can be deadly. Keep in mind that although your hospitalized loved one may not have any of these diseases, others in the hospital do, and you don’t want your child leaving the visit with something he didn’t come in with. So although it may cheer Grandma up to see her grandchildren, think of how terrible she’d feel if that visit made her grandchildren sick. Ask about your hospital’s age guidelines for visitors, and stick to them.
Even if you’re doing the best you can to manage your health care, chances are there’s room for improvement. Nurses can be good sources of advice on how you can do better. From choosing your providers carefully to keeping your hospital visitors safe, small changes can make a big difference in how you get and keep yourself healthy.
Carre Armstrong Gardner is a registered professional nurse. In 23 years of practice, she has worked in cardiology, oncology, medical-surgical, orthopedics, critical care, and addiction medicine. She currently works as a perianesthesia nurse in Portland, Maine. Carre is also the author of three novels, the most recent one being They Danced On (available July 1, 2016; Tyndale House). Learn more at carregardner.com.