Understanding Healthcare

Understanding Healthcare is necessary to Become an effective Patient Advocate

Becoming an Advocate Requires Understanding Healthcare

 

     When you take on the role of caregiver, you become responsible for your family member’s daily care duties, but you also become their advocate. Understanding healthcare is essential to work within the medical environment in getting anything done.  Healthcare systems are complex.  A strict reporting line of leadership exists, and roles are well defined. Staff only do what is in their job descriptions, so it’s pointless to ask them to do something else.  Therefore, if you need help, you must know whom to ask for what.

 

Healthcare Highly Regulated

     Clinical teams are strictly regulated.  Laws and regulations rule everything; therefore, asking them to do anything out of the ordinary takes an act of Congress.  By the time it’s approved, you may not even need it. There’s red tape on top of red tape, and decisions can’t be made without a “multi-disciplinary” committee reviewing the request and three layers of approval blessing the decision. 

 

Healthcare Places a Lot of Emphasis on Education

 

     Educational levels are a big deal with all disciplines these days, and credentials speak volumes. Therefore, unfortunately, many professionals tend to look down on their customers without college educations. They assume they are unable to understand information, talk over them, or lead them in making decisions a particular way without all the facts. They fail to provide details of lab reports and imaging results (X-rays, CTs, or MRIs). The medical staff and often the leaders in nursing talk “down” to the caregivers and family in a condescending manner. Therefore, knowing the healthcare language and talking the talk is essential. If you can hold your own in a conversation on the health topic under discussion, you will earn their respect, and they will include you after that.

The family makes all final decisions

 

     Family Controls Medical Care

     You must also remember that you and your family member are the captains of this ship—not the medical team.  They work for you and not the other way around. You know your family member’s history better than anyone.  You know how they are responding better than anyone. Stand your group if you believe they need something different from what the doctor advises. Make them listen and talk to you.

 

Decision Making Authority

     You may have to prove you are the Power of Attorney (POA) or Medical Decision Maker for your family member to make the necessary decisions if your family member is unable to make their wishes known.  If you do not have legal authority, you need it before healthcare officials recognize your right to speak on behalf of your family member. No one will listen to you if you do not have that unless your family member is legally declared incompetent or has died. Chances are you do not want either to occur; therefore, a POA is the next best choice.

 

Power of Attorney Designation

     Once you establish yourself as the POA, and the family member defers all conversations to you, the medical community will begin to work with you. However, it’s good to keep a copy of your POA document with you to present whenever you are going to meet with a new healthcare person for the first time because healthcare personnel do not talk to one another. You almost always repeat your story multiple times down the line, which includes showing the same documents to each of them along the way.

 

Always Keep These Documents with You

     Take a copy of the following documents with you every time you go to the hospital or doctor’s office:

  • your Power of Attorney,
  • your family member’s insurance cards,
  • government-issued identification card (driver’s license),
  • a list of all prescribed medications,
  • over-the-counter medicine they take,
  • diet supplements (vitamins, minerals, etc.), or
  • herbal supplements (home remedies).

     If your family member has any implants or transplants, keep the essential information about those with you. I have a zipper pouch I use to store mine and update the contents after each medical appointment with any changes made to his medication list so that it stays current.

 

Understanding Healthcare as a World Unto Itself

Patient Responsibilities

     When you enter a healthcare facility to receive care, the fact that you voluntarily came to them for help implies consent for treatment and establishes an agreement between you and them for services. Therefore, from the minute you come there with the intent of being a patient, you have specific responsibilities. If you do not intend to accept the help the healthcare team offers, if it’s reasonable, then do not go there. If you have an issue with the assistance provided, then discuss your concerns with them in a respectful manner.

     

     Most healthcare professionals are genuinely in the profession to help people and to do the best they can every day in a difficult situation. If you talk through a position with them, most of the time, you can work something out. 

 
As a patient, you are responsible for the following:
  • Completing your admission and billing paperwork accurately.
  • Asking questions if you do not understand something and letting your doctor know if you do not want to follow a plan of care offered.
  • Giving your doctor and the hospital a copy of your advanced directive if you have one.
  • Following your plan of care, once you go home, including buying the supplies, medications, and other items, you need to take care of yourself.
  • Leaving your valuables at home, so they do not get lost at the hospital.
  • Being respectful to everyone, following the rules, and being safe.
  • Paying your bills as agreed.

Understanding Healthcare - You are the Most Valuable Member of the Team

Key Player in Healthcare Team 

   As the caregiver, you are one of the most important members of the healthcare team. Other than the patient, you may be the most important because you are the only one who knows the entire story. You know what is going on from all sides – at home, at the hospital, at every doctor’s office, at every therapist’s office, and with the insurance companies. You also have a past medical history and know first-hand (because you experienced it) what treatments worked since the last visit with the doctor. In fact, you might know better than the patient at times because the patient may have been confused during part of recovery, currently, or just not want to tell the doctor the truth.

 

MVP – Most Valuable Player

     You are a wealth of knowledge. You may not realize how much you know but you are invaluable to the healthcare team—often more so than they realize, as well, which is why I want you to learn how to talk-the-talk with them so they will listen to you. One of your greatest challenges will be to get some of the doctors to respect you and see your value to them. That’s not true of all of them but many of them will talk over you.  Don’t let them. When they make assumptions or say things that are not true about your situation at home, correct them. When they want to do something that will not work for your situation at home, speak up, and say so. Ask questions and involve yourself in helping to make the decisions about your family member’s care.

Surgery in progress

Understanding Healthcare helps when Talking to Your Doctor

Speak the Truth; They Need to Know

     When my Mom had cancer, she was somewhat uncomfortable most of the time; however, every time I took her to see her Oncologist and the doctor asked her how she was doing, my Mom responded with a cheery, “I’m doing great and how are you?” 

Helping my Mom up during the chemo period of cancer treatment

     Why would she do that? She was obviously in pain. The answer was because she LOVED her doctor. She could not stand to disappoint her doctor by saying she felt terrible. The doctor understood my Mom and would instead ask me for details about her condition. 

Clarify Misunderstandings    

   As the caregiver, sometimes, you must be the truth-teller. Patients sometimes need to live in denial for a while as they adjust to different stages of illness. Other times confusion or memory loss interferes with accurate storytelling requiring the caregiver to intervene. I often allow the one under my care to relay their story first, and then I supply details to clarify misinformation as needed. Occasionally the person under my care, and I disagree on the details, but usually, the doctor explores the differences in more depth to determine for himself where the difference lies.

Truth is Vital

     It is vital to give healthcare providers pertinent information related to changes that happened since the last visit. A change in behavior or primary body function can indicate something to a healthcare provider that a layperson would not consider. Intermittent events often serve as warning signs of something more serious about to happen. As a caregiver, our job is to give the doctor the details and let him decide what is pertinent. Therefore, tell them everything.

All hospitals are licensed by the Department of Health and accredited by the Joint Commission. If you have a complaint or concern, contact the Patient Relations or Guest Services office first to see if they can help you resolve the issue.  If your attempt to resolve an issue internally is not successful, you have several options for addressing your complaints outside the organization.

The Joint Commission investigates issues related to patient safety and quality of care. Go to their website at  https://www.jointcommission.org/resources/patient-safety-topics/report-a-patient-safety-event/  to get the form you need to fill out and to find out more about filing the report.

The Virginia Department of Health

The Office of Licensure and Certification (OLC) investigates consumer complaints regarding the health care services received at the facilities and services it licenses or certifies.  The OLC is responsible for nursing facilities, inpatient and outpatient hospitals, abortion facilities, home care organizations, hospice programs, dialysis facilities, clinical laboratories, and managed care organizations. To file a complaint go to http://www.vdh.virginia.gov/licensure-and-certification/complaint-unit/

The Center for Medicare and Medicaid Services (CMS)

You can file a complaint if you have concerns about the quality of care or other services you get from a Medicare or Medicaid provider. To submit a complaint to CMS go to their website at https://www.medicare.gov/claims-appeals/how-to-file-a-complaint-grievance

Board of Health Professions – Virginia

The Department of Health Professions receives complaints about Virginia healthcare practitioners who may have violated a regulation or law. Claims for all thirteen licensing and regulatory Boards are received and investigated by the agency’s Enforcement Division. For more information their website is https://www.dhp.virginia.gov/PractitionerResources/Enforcement/FileaComplaint/

Understanding Healthcare - Your Rights and Responsibilities

As your family member’s power of attorney, you have the legal right to speak up on their behalf if you feel their patient rights are being violated when receiving care in a hospital, as an outpatient, in hospice care, or in another managed care facility. The Joint Commission established standards for patient rights applying to all healthcare organizations. The Joint Commission oversees all organizations that accept federal funding; therefore, these standards are consistently found throughout the United States as a fundamental right for all customers of healthcare services.

Let’s look at these Rights closer under “Rights to have Effective Communication” and “Rights to be Treated with Dignity.”

Responsibilities

     As a caregiver, it is vital that you have a thorough understanding of the healthcare system within which you function to safely navigate the potential pitfalls. When you enter a healthcare facility to receive care, the fact that you voluntarily came to that facility for help implies consent for treatment and establishes an agreement between you and them for services. It’s called “implied consent.”

 

     With implied consent, the medical team can assume you want to accept care from them if you become unconscious and cannot speak up for yourself. The unspoken agreement also establishes an expectation of competent care from the healthcare team and responsible behavior by you. Therefore, from the minute you become a patient, you have specific responsibilities. If you do not intend to accept the help the healthcare team offers, if it’s reasonable, then do not go there. If you have an issue with the assistance provided, then discuss your concerns with them in a respectful manner.

 

     Most healthcare professionals are genuinely in the profession to help people and to do the best they can every day in a difficult situation. If you talk through a position with them, most of the time, you can work something out. 

 

You are responsible for the following:

  • Completing your admission and billing paperwork accurately.
  • Asking questions if you do not understand something and letting your doctor know if you do not want to follow a plan of care offered.
  • Giving your doctor and the hospital a copy of your advanced directive if you have one.
  • Following your plan of care, once you go home, including buying the supplies, medications, and other items, you need to take care of yourself.
  • Leaving your valuables at home, so they do not get lost at the hospital.
  • Being respectful to everyone, following the rules, and being safe.
  • Paying your bills as agreed.

As a consumer of healthcare services, caregivers always have a right to be treated with respect, as does the family member under their care. 

  • To be treated with courtesy and respect by everyone who represents the organization and to not suffer denial of services or be mistreated based on any discriminatory reason including but not limited to race, color, gender, age, disability, sexual preference, nationality, political affiliation, marital status, religion, or genetic information.
  • To practice your religious or spiritual beliefs and to discuss those beliefs with those willing to do so.
  • To know the names of the people who provide your care.
  • To have your healthcare information remain private and confidential unless you authorize its release. 
  • To limit the use of any pictures or videos taken of you to what you approve or to assist in your care
  • To have an advocate with them during their care
  • To be informed about your care
  • To have your healthcare team listen to you regarding how you feel about your medical needs
  • To be allowed to make your own decisions regarding your treatment choices, including the right to refuse all or any part of any treatment you do not want to do
  • To have the information provided to you in the way that meets your needs ( such as if you are hearing impaired, they need to provide you with an interpreter, or if you cannot see to read, you need to have information provided orally)
  • To receive copies of test results and medical records (which includes the patient chart during the hospital stay or afterward)
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