My first thought as I finished reading this book was, “Where Was This Text when my family needed to spend time in the hospital?” This book is a reference book of what you need to know about the medical system, before you need to know it. I appreciated the author’s candor in approaching the subject of this book from someone who has a depth of professional experience, to her audience whose surface experience has been on a need-to-know level. As the author says, “There are quite a few things that we, as a healthcare team, assume you know.” She then further says, “I feel like we could do a better job of informing our patients of what to expect.” This book is written from the assumption that you will be a patient in the hospital, or an advocate for someone else who expects to be hospitalized.
The logical flow of the sections is a helpful progression where the author first relays information to gather before the hospital stay; next comes information pertaining to the actual time in the hospital, and advice you can use during treatment and after discharge. Peppered throughout the book are Patient Tips highlighted like a prompt so you recognize it as something you might want to remember. Here’s one taken verbatim from section one. Patient Tip! It is always okay to ask, “Who are you, again?” to someone who comes into your hospital room and starts asking questions. It is never rude; you need to know and fully understand your entire care team, especially if it is a new face.”
One thing this book does not do is discuss particular conditions, diseases or any form of diagnosis that would require hospitalization. This is a Playbook for patients and their caregivers. It’s intent and purpose is to answer questions that you may never verbalize because, the truth is, you don’t know what you don’t know.
Medical teams are comprised of a diverse set of people with specific skills and certifications. Besides doctors and nurses there are medical and surgical specialists, therapists including physical, occupational, respiratory, and speech. There are also pharmacists, dietitians, chaplains, social workers, case managers, secretaries, and others. In section one the author, Kati Kleber, pulls back the curtain on each of their roles and discusses responsibilities, relationships of the roles to each other, and how the collaboration of them working together assures full quality care of each patient. Kleber anticipates multiple questions that patients have and answers them carefully, yet generically enough to apply to any hospital stay.
Some of the more obvious are questions that explain the difference between attending physicians, consulting physicians, residents, interns and medical students. I appreciated the descriptions of several medical specialties and what specialists do. Oftentimes during and after a stay in the hospital the patient will be seen by a specialist. Using information from the expert sources, the author includes explanations of specialties such as hospitalists, neurology, pathology, anesthesiology, and internal medicine. She also delves into the realm of surgical specialties and what surgeons do. To name just a few from the pages, general surgeon, thoracic surgeon, neurosurgeon, and here’s one I had never heard of, otolaryngology surgeon for the ears and connecting structures. I was intrigued by the unique types of specialties patients might encounter, and as the author makes clear, even with all those specialties and responsibilities she wrote about, the list is still just a small sampling.
My favorite part of the book was the section titled Your Hospital Stay: Getting Admitted, Treated, and Discharged. Most people like the word discharged more than they like the word admitted, and once they are admitted they are ever striving to see those discharge papers. What happens between those events is often a mystery. Kleber starts at the source of admission to the hospital, be it through a doctor’s office, after surgery, or due to an emergency room visit, although there are others. The book talks about the units (or floors) and levels of care considered for each patient. Do you know what it means when doctors and nursing staff choose the unit the patient will be admitted to? Of course it makes sense that heart patients go to a cardiac unit where patients who have a stroke are taken to the unit customized to expertly care for people who have had strokes. But when you hear ‘step-down unit or intermediate care or critical care or intensive care, do you know how they compare and what that means for level of patient care?
If you haven’t been to a hospital, you’ve at least watched TV where it seems every show has at least one scene where a patient is in a room hooked up to machines that beep and flash. The author provides a sufficient degree of information about equipment typical in hospitals. The most basic of items, being the call bell, which is there for a purpose, and patients should be comfortable in using it. I read with fascination about the IV Pump, Heart Monitor, Oxygen Therapy Devices, and especially the SCDs – Sequential Compression Devices. Maybe you knew that they were to prevent blood clots, but I only knew SCDs give leg massages by gently squeezing one leg at a time.
Several pages are devoted to medications, not specific meds, but Kleber gives us valuable insight about the process of adjusting medications and consistent monitoring during changes of both medications and schedules. This isn’t always a factor, but in the book the author discusses what happens during adding medications and administering them in the hospital. Maybe you’ve visited a doctor and been asked, “What’s your pain level today?” I always wonder how to assess pain on a scale when there is nothing to compare it to. I get it now. On page 65, there’s a chart that plainly defines pain at levels zero to ten. Since this book was written as a carry along guide with questions and note taking pages in the back, I can envision having this book with me on my next doctor visit – even though this book is essentially written for people who expect to be hospitalized.
Section three is perhaps the most important one to read, even if no hospital visits are anticipated. Some things are obvious, such as having an emergency contact person on record. Others such as, advocating for yourself and escalating issues when your medical care are not going well, were not known to me. I read, “Know Your Code Status” and thought, what is that? If you know, you’re way ahead of me. The author states, “We need to know exactly what you want us to do if you stop breathing, your heart stops, or both. We are required to ask you this question every single time you come to the hospital. We must know, beyond a shadow of a doubt what you would want done in that situation.” I’ve been asked if I have an Advanced Directive, but this part about knowing my code was new to me. Kleber does a good job on covering this sensitive topic from having the conversation and making sure everyone in your support system is aware of what the Health Care Power of Attorney states.
From the outset it’s not just the health of the person, there is the ambush of care details after the illness occurs, and all this can lead to information overload. Kati Kleber thoughtfully included a final section where she asks questions of the reader and then provides pages where you can write your own questions and take notes. This book was easy to read and the pages are filled with exactly what the author intended for readers to learn. What You Must Know When Going to the Hospital is an appropriate title.
