An advocate for patients might save your life in the hospital

by Dennis Grace

So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.

Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big deal? I didn’t have an advocate when I was in for observation after a concussion at age eight or when I had my tonsils out at age ten or when I had pneumonia at age twelve. Hospitals were supposed to be the safest place to be when you were hurt or sick. Of course, at ages eight through twelve, I had my parents there making sure I got the best possible care. Still, I didn’t seem to need someone there all the time.

Anyway, I’m an adult now. Why should I need a babysitter?

For one, hospitals are more complex and dangerous places today than when I was a kid. Antibiotic-resistant infections run rampant in hospitals across the globe. Doctors, nurses, orderlies, therapists, technicians are all required to wash their hands when they go from one patient to the next. Repeated surveys, though, show that many aren’t doing so well at this. Someone has to be there to be sure the hand-washing happens.

Plus, today’s hospitals are busy, hurried businesses. Every filled hospital bed is one less available for the next customer. They want you out almost as soon as you’re in. In that kind of rush, mistakes are made. Every year, thousands are harmed and many die, simply because someone misread a prescription. Someone needs to be there for you to make sure you get what you need (and don’t get what could harm you). That someone should be an advocate who knows what drugs you’re supposed to get, someone who can ask questions for you when you’re unconscious or when you’re just not quite yourself.

(Note: When I say “advocate,” I don’t mean someone who works for the hospital. Many hospitals offer the assistance of in-house advocates. Think of them as ombudsmen. They work for the hospital to facilitate communication, but you don’t want a communicator whose first duty is to the hospital. You need someone who works for you.)

When I was in the hospital for major surgery a few years ago, Kathy, my wife, took off work and stayed by my side from the recovery room until my discharge. She left only a few times to eat and to check on our daughter. I remember thinking, “She really doesn’t need to do this” and at the same time being deeply grateful that she was there. Every time I awoke, she was there beside me in that terrible visitor’s chair: sleeping, reading, waiting.

I can’t imagine how horrible my stay would have been without her. When I first woke from the anesthesia, I fell into an ocean of nausea. Even though I hadn’t eaten a bite in the preceding twenty-four hours, I wanted more than anything to throw up. The combined painkillers were apparently more than my stomach could stand, even with a powerful anti-emetic. The post-op pain was intense, and that plus the nausea left me a lump of groggy nothingness. The only clear thoughts I had were wanting to throw up and needing to escape the pain in my back.

Kathy worked with the doctor to get me onto a painkiller regimen that worked for me. My stomach eventually settled, and I was eating again by early the second day. Freedom from the pain and nausea allowed me to begin the movement I needed for recovery. Kathy was more persuasive (and insistent) than the physical therapist at getting me on my feet and walking. First, it was just to the door and back. Then it was just outside the room. Then ten floor tiles from the door—twenty—down to the nurses’ station. Without Kathy’s presence, I doubt that my progress would have been so rapid.

Kathy got the nurse in to change my slipping IV needle. She made sure that I ate right. She checked that the doctors, nurses, and therapist used the hand-wash station just inside the door to my room. She also made sure that someone promptly answered the alarms on my pain-meds injector and checked every new drug I was given, including the IV bags.

During my second week, I was moved to an inpatient rehab center, and Kathy returned to work. I missed her, of course, but I got to see her during visiting hours, and frankly, I no longer needed an advocate by my side. On my own, I could move around without constant coaching, make sure the staff washed their hands, and get the doctor when I needed her. Plus, I no longer had tubes and wires trailing from my arms.

Having experienced one inpatient week where I needed an advocate and a second week where I didn’t, I think I understand the dividing line between the two kinds of stays. If you expect to be unconscious, disoriented, or disabled—no matter how briefly—you should have an advocate. If you are as lucky as I was, you have a loved one who can fill that role for you. If you don’t, though, you might want to consider hiring someone to do the job. Even if you do have a caring spouse with time available to advocate for you, he or she might not feel knowledgeable enough to fill that role. It is a lot of work.

Remember that medication errors and antibiotic-resistant infections kill even young and otherwise healthy patients. Don’t let your ego get in the way of your safety and health. At least until you’re sure that you’re in a stable, alert condition, have an advocate by your side to provide the diligent attention that a drugged and disabled you can’t provide.