Patient Advocacy For Good Times and Bad

Becoming medically prepared can be one of the most difficult aspects of prepping.  First, there is the unpredictable nature of medical emergencies themselves.  Then there is the prospect of inadequate medical training coupled with the lack of supplies and medicine.

Even during normal times, doing the right thing medically can have dire consequences.  Something you may not have considered is the need for patient advocacy, both now and in the future when the prospect of getting good proper medical care is not likely.

Dr. Joe Alton is back again with an all-new and all-important article of medical preparedness.

Advocating for the Patient in Good or Bad Times

We spend a lot of time talking about medical issues in natural and man-made disasters. However, a calamity can also be very personal, such as when you or a loved one suffers a major medical emergency, whether in good or bad times.

In many instances, it is easy for someone like this to “fall through the cracks” of a huge medical establishment. I know this happens, as I saw the results of it as a resident in a large inner-city hospital. The lack of having an advocate, for example, in an epidemic setting can be very hazardous to your health.

A similar scenario that could have been fatal also happened to one of our sons, Daniel. Daniel is a 32-year-old who has had severe diabetes since he was nine years old. Due to his disease, he had developed kidney failure, partial blindness, circulatory problems, and had been on dialysis for more than a year. He had been on a transplant waiting list as well.

After a number of false alarms, a kidney and pancreas became available as a result of a drunk driver taking the life of a young father of two as he was riding his bicycle. Daniel underwent transplant surgery at a large city hospital, one of the few in the state that performed this type of procedure.

The good news is that the new organs functioned well from the very start, producing urine and lowering his blood sugars to almost normal levels within 24 hours. Several days after the operation, he was deemed fit enough to leave the Intensive Care Unit and go to a regular floor. This meant that, instead of having a nurse specifically for him, he shared a nurse with several other patients. This is standard operating procedure and usually, has no ominous implications.

However, when we went to see him the day of his transfer, he wasn’t looking well. He seemed pale and his abdomen seemed more distended that it did before. There was a drain coming out of his belly, and it was full of bright red blood.

As a surgeon, seeing a drain with some bloody fluid isn’t that unusual. But the sheer volume of blood draining out of his abdomen was concerning. Nurse Amy and I took it upon ourselves to check Daniel’s vital signs earlier than scheduled and found him to have a racing pulse and a dropping blood pressure. As we were unable to find medical staff, we emptied the bloody drain and watched it rapidly fill up again (and again) in short order. It was clear that he was bleeding internally.

This occurred in the wee hours of the morning after most visitors had left. Staffing was light, and it took some time to find his nurse, who was attending another patient. Our hackles were raised, and we’re not ashamed to admit that we raised a racket. An overworked resident came in to take a look at him. To her credit, she realized that something was wrong, and he returned to the operating room. They wound up removing 3 or 4 liters of free blood from his abdomen before the hemorrhage came under control.

Daniel recovered from this ordeal and, thankfully, his transplanted kidney and pancreas are still functioning. However, thinking about this episode, it was clear to us that it could have ended very badly. If not identified in time, it’s very likely that we would have received a call in the morning notifying us that Daniel had passed away during the night.

We tell you this story not to gain sympathy or a pat on the back, but to convince you of the importance of being a patient advocate. Our advice is not just for family members. If you are working to become a better medical asset to your people in hard times, then you must take patient advocacy as serious as learning first aid. You must walk a mile in the shoes of your patient.

You may already see yourself as an advocate for your patient. Indeed, most doctors today feel they know what’s best for their patients. I certainly hope it is this that guides them; that they would do for their patients as they would for a member of their family. As a medic in a disaster, however, you may be overworked and under stress.

This may make it difficult for you to see things from your patient’s perspective. Your patient may “fall through the cracks” if you’re not careful, simply due to the amount of pressure on you to care for a large survival community.

Consider appointing a family member or other individual to follow a sick patient with you, not necessarily to provide care but to provide support as an advocate. Allow your patient to participate in medical decisions regarding their health and never resent their questions. If they are too weak to do so, communicate your plan of action with their appointed advocate.

Three A’s of Patient Advocacy

Here are Alton’s Three A’s of Advocacy

1)   Accept the importance of a patient’s right to be informed and, if possible, participate in medical decision-making.

2)   Advise the patient so that they understand the medical issue in question and can be a full partner in the therapeutic process.

3)   Allow an advocate to be an intermediary if the patient is too weak to actively participate in their care.

Hard realities may make it difficult to provide quality, informed care in times of trouble. Unfortunately, medic, that is your duty; it’s a responsibility that’s as imperative in bad times as it is in good.

The Final Word

It is not difficult to imagine a time or a place when medical help may not be readily available.  The scenarios are many.  Following a catastrophic natural or manmade disaster, during a pandemic, or even a during a vacation to a remote location.  In each of these cases, you may have to take patient care under your own wing and do the best you can to ensure a good outcome.

In those circumstances, do the best you can, keeping in mind the Alton’s three A’s: Accept, Advice, and Allow.  As a matter of fact, start practicing them now.  They could be a game-changer.

Enjoy your next adventure through common sense and thoughtful preparation!