Newspaper Page Text
THE ISLANDER, APRIL 13, 2009, PAGE 7
(News to Q-CeCv
The Best is Yet to Be
By Clark Gillespie M.D.,
Professor Emeritus, the University of Arkansas
Hospital Bound
Readers must have seen - very
recently - a national report which
revealed that a significant and grow
ing segment of our population return
to hospital within a month of our dis
charge home. This return is apparently
due to a failure of our home care in
managing the condition for which we
were originally hospitalized.
It is clear from these reported fig
ures that we seniors represent a great
number of such returnees. The report
did not make clear whether our big bite
in this federal-figuring was because
there were relatively more of us put
into hospitals, or whether we were just
the major homeward-bound screw-ups.
Our generation believes the former
explanation while generation X and Y
believe the latter - assuming that they
believe anything.
Whatever, early hospital re-admis-
sion is a growing problem in our society
and the Johns Hopkins Health Letter
has recently offered some explanations
for this remarkable phenomenon, and
some advice about re-admission dodg
ing.
The Hopkins report starts out by
reminding us that while we are in
patients we are really not responsible
for our medical care nor for some major
aspects of our personal care. Very
abruptly following hospital discharge
we - or our personal advocate - become
totally responsible for both our medical
and our personal care.
Although our hospital admission
event has been more completely docu
mented and recorded than is a federal
appointee’s vetting, we often leave hos
pital without any organized instruc
tions and advice to keep us on our
proper medical course. Such instruc
tions that are provided may come in
part from our nursing attendants, from
our physicians, and from consulting
nutritionists, physical therapists and
others, but they are often very sepa
rated and disjointed and some may be
written, some oral.
Moreover medications can be hand
ed out to us, or be given to us in
prescription form when departure is
being implemented. So, many of us
arrive home, our brains battered by
some illness or surgery, or by being
confined to a “Darth Vadar” designed
bed, and finally, by being obliged to
remember more disjointed instructions
and medications than does a departing
astronaut.
In order to manage this separation
event so that we can continue to live
successfully whilst away from our hos
pitals, here follows some advice worth
considering and remembering - but
first, don’t let them put you out too
soon!
• We should ask for written instruc
tions from all our providers. Although
that clearly puts the compliance bur
den more directly upon us, it at least
gives us something to comply with or
fail against.
• If medications are provided to take
home, we need to be sure that the tak
ing instructions are clear and that they
include the dosing duration and the
potential side effect that any of them
may produce. Written prescriptions
must be given for any continuous pill
taking. There is no way of determining
in advance if the written instructions,
interpreted by a pharmacist will be
clear to us so a physician call may
be needed. We further must know if
any new medication will interfere with
some we may already have been tak
ing. And - should we continue to take
any prior medication?
• We must try to establish a reliable
communication line with any of the
special services that worked with us
during our stay - just in case we should
have an urgent need for assistance at
home that we cannot get answered
elsewhere.
• Ask to be provided with some
understanding of how we should feel
while we are recovering, what we can
do, what are our limitations insofar as
diet, bed rest, physical activity, exer
cise, habits, sex and other sporting
activity , and further, what are the
abnormal convalescent signs of which
we must be aware. Certain hazards
and complications may occur after any
illness or any surgery, and we must be
aware of those that might involve us.
Many times it is advantageous to
appoint a personal advocate to assist
with this homeward transition. Such
an advocate could be a family or friend
resource or, if necessary, a paid health
care worker. Such a representative
should have designated responsibili
ties and be allowed access to medical,
instructional, even some financial areas
involving their patient, and should be
fully advised and be well aware of
that persons condition, limitations and
needs. This personal advocate is, of
course, that patients firm link with the
hospital experience and it appears to
work very well.
With all these present and growing
concerns about hospital departures, it
might be wise to for our medical lead
ers to establish a series of printed hos
pital discharge instructions that can
Turn to Page 10 - Dr. Gillespie
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