#20 - 6 February, 2024
CONTENTS
?? The golden years need a positive spin
?? The profound impact of chaos on our lives and decisions
?? LEAD ARTICLE: How good was your hospital stay? A rating guide.
?? Second helpings - good reading from the web
The golden years need a positive spin
Fang C, The Conversation. February, 2024
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We are living longer than ever. Life expectancies of 70 - 80 years are not unrealistic. Historically, older individuals were esteemed for their wisdom, but industrial and societal changes have marginalised them, associating ageing with unproductivity and a burden on social systems. This attitude is further fuelled by societal emphasis on youth, reinforced by anti-ageing products and innovations in biomedicine. The end result is a fear of ageing.
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"Once we understand ageing as a regular experience, we can let go of these worries and approach the journey through different life stages with a positive attitude and a fortified will to enrich our lives and the lives of those around us."
"To be interested in the changing seasons is a happier state of mind than to be hopelessly in love with spring." - George Santayana
The profound impact of chaos on our lives and decisions
Klass B, The Guardian. January, 2024
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We like to believe in free will and the idea that our destiny can be controlled by individual effort. Can it, really? This article probes the intricate nature of chaos theory and its pervasive influence on both historical events and individual life paths. Seemingly minor incidents can have profound, unforeseen consequences due to the interconnectedness and sensitivity of complex systems.
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"The paradox, then, is that we control nothing, but we influence everything."
"It is a mistake to try to look too far ahead. The chain of destiny can only be grasped one link at a time." - Winston Churchill
LEAD ARTICLE
How good was your hospital stay? A rating guide.
Earlier on (Prescription # 13 ) we looked at how perception of outcomes of treatments can differ markedly between care-givers and recipients of care—the patient. Extending this further, let's take a look at how patients should view their overall experience with any healthcare organisation. The items listed below are, in my opinion, good indicators of the quality of care during an inpatient stay.
Patients worry that being too questioning could go down as a lack of respect for the doctor and lead to poorer quality. Remember, it's your body that is at stake and your resources that are being spent. What may be a small percentage from the doctor's point of view is always 100% from yours. Either it worked or it didn't.
Group I: Quality of medical care
? Quality of the doctor's interaction. It's easily the most important aspect of the entire experience. As Maya Angelou said, people will seldom remember exactly what you said but will always carry with them how they felt about you. Holds true for opinions about a doctor. Rate your doctor on the following traits:.
Even when outcomes are adverse and not in keeping with expectations, patients think well of their doctor if she scored high on this list.
? Quality of nurses' and other carers' services. The same criteria are applicable here. In most hospital stays, patients deal with nurses and other care-giving professionals to a greater extent than the doctor.
? Explanation of the medicines and treatments received. In (Prescription # 17 ) we saw how compliance with prescribed treatment was closely linked to the manner in which prescriptions were handed out. Cursory, perfunctory styles don't go down well. What is routine for doctors is one-of-a-kind for the patient—a unique experience full of doubts and anxiety.
? Explanation for the tests ordered. Hospitalisations will involve undergoing a long list of tests. Did you receive a good explanation of what each test was meant for? Once the results came in, did your doctor go over them in detail and give you his opinion?
? When performing procedures on you, did the doctors and nurses use gloves? In the interest of hospital infection prevention, care givers must wear gloves when examining any part of your person or carrying out bedside interventions, even for brief periods. The hands of healthcare professionals are the #1 source of infection spread. Indeed, even the garments of doctors can be responsible for the transmission of infection between patients. You might have noticed that many doctors no longer wear the iconic white coats. They are washed irregularly and can be agents of transfer. So too with ties and other loose-hanging apparel.
? Was an antiseptic handwash used before and after procedures? One of the greatest discoveries in infection prevention was Ignaz Semmelweis' recommendation from two centuries ago for washing hands between patients. Modern antiseptic hand washes are powerful and effective agents. They should be available at all points of care.
? Was nutritional counselling given? Often neglected, make sure that your queries and doubts about diet and nutrition are addressed, if possible, by a qualified and experienced dietician.
? Promptness of help when requested. How long did it take between ringing the call bell and getting someone to come in?
? Quality of pain relief. Were you kept reasonably free of pain during the stay? Were you able to sleep well?
? Duration of hospital stay. Did you feel that the number of days you spent in the hospital was adequate? Were you kept in the hospital well after you could have taken care of yourself at home, or were you rushed to discharge before you felt ready?
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Group II: Ambience of health care facilities
Although not critical, poorly kept and maintained facilities are often examples of the "broken window effect."
? Cleanliness and maintenance of rooms and bathrooms. Were the rooms and wards kept clean and orderly at all times? Were housekeeping staff regular in their duties?
? Cleanliness of bed linen. Were they changed regularly? Were they changed when soiled in between scheduled changes?
? Quietness around your room or bed.
? Security and crowd control. Was your hospital an orderly, quiet, disciplined, safe, and well-regulated place, or did it feel like a mela or carnival?
Group III: Discharge summary
A discharge summary is the most important record of your hospital stay. A good-quality hospital discharge summary should be complete, clear, and structured to ensure continuity of care. It is the vital link in future visits for care. The following heads are typically included:
1. Patient information: This includes the patient's name, date of birth, hospital ID number, and admission and discharge dates.
2. Admitting diagnosis: The primary reason for hospital admission.
3. Hospital course: A summary of the patient's condition throughout the stay, including significant findings, interventions, complications, adverse reactions, and the patient's response to treatment.
4. Procedures and treatments: Details of surgeries, procedures, therapies, and medications administered during the hospital stay.
5. Discharge diagnosis: This may include the admitting diagnosis and any new diagnoses discovered during the hospital stay.
6. Patient's condition at discharge: This includes the patient's health status at the time of discharge, including improvements or complications.
7. Medications at discharge: A list of medications prescribed at discharge, including dosages, frequency, and duration of use.
8. Follow-up care: Instructions for follow-up appointments, tests, or therapies. This section should include information on which healthcare provider(s) to follow up with and when.
9. Diet and activity instructions: Advice on diet, physical activity, and any restrictions post-discharge.
10. Patient and family education: Information provided to the patient and family about the patient's condition, medications, follow-up care, and any home care instructions.
11. Pending test results: Any test results that were not available at the time of discharge but are expected to be followed up on.
12. Post-discharge care: Information about any arrangements such as home health services, rehabilitation, or equipment needs.
13. Signatures: The primary healthcare provider who is in charge of the patient's care should sign and date the discharge summary.
Group IV: Business processes
? The quality of the bill given. Did you get a well-itemised list, or were some numbers scribbled on a scrap of paper and handed over?
? Transparency of transactions. Were all your payments explained and accounted for? Were you asked to pay in cash, unreceipted?
? Your total bill was: Lower than expected/ estimated; equal to expectations; higher than expected; or unpleasantly higher than expected.
Group V: Overall impressions.
A good index of quality, and not just for healthcare, is the enthusiasm and willingness to recommend the facility. How would you recommend this health care facility to your friends and relatives?
Just as we look at certain benchmarks in consumer experience, so too do we need to with healthcare. It cannot be considered exempt. Against the background of hospital costs rising at alarming rates, patients have every right to expect standards of responsibility that are prevalent in the consumer-centric world.
SECOND HELPINGS
Good reading from all over
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