Hospital Patient Advocate Call

 

Due to that brief polite call I made regarding the rib fracture issue. 

As I said, I wasn't mad, I just thought they'd want to know, because this isn't their usual AND because documentation is extremely important in motor vehicle accident insurance claims.

I was surprised with the way she started out, she kind of came at me. 

Not an attack or rude necessarily, but definitely not what I expected or I wouldn't have taken the call.

Of course, I have no experience with patient advocates - I assumed they were there to listen to concerns, just based on their title - NOT to defend the hospital to you as if they're a lawyer lol.

Then she brought up the fact that I signed myself out on AMA regardless, when it was clear he wanted me to stay for 24 hours for "internal injuries."

Um, no - so I gently pushed back ...

"Well, now, wait just a minute, here - first of all, this happened long before I signed out - so what we're NOT going to do is pretend like if I hadn't, this wouldn't have happened." 

"Speaking of his notes, he said he recommended a 24-hour observation unit to 'monitor for POTENTIALLY delayed internal bleeding ' - NOT - "known internal injuries" - there's a big difference."  

"That is because there was no question about the back fractures, we already knew it was there by then; thus, why I was referred to outpatient treatment hours before I signed out." 

"If the reason was, as you say, known internal injuries overall, then he would have admitted me immediately, rather than just a 24-hour observation unit - but he didn't, did he?" 

"Therefore, his recommendation for a 24-hour observation was ONLY to monitor for RISK of internal bleeding -  NOT internal injuries overall."

"I signed out AMA after 6-1/2 hours in the ER with stable vital signs, no signs of internal bleeding, only after the referrals were made, as well as after I asked first the nurse, then  doctor. I did so because I was worried about the cost." 

"The nurse, and even the doctor later, agreed that "if internal bleeding was going to happen, it most likely would've happened by now" and that I was 'likely out of the woods, they just wanted to be sure" on the internal bleeding" and "vital signs are still stable and good"  so they will consent to signing myself out - *IF* - I understood the explained risks and warning signs of internal bleeding to watch out for." 

She conceded this was, in fact, the case - he DID say internal bleeding - NOT - internal injuries overall.

She asked me if I'd made that outpatient appointment with Neurosurgery.

 

Me: "Oh, glad you mentioned that - did you all know that we are currently short on neurosurgeons in this town? I didn't.  In case you didn't know, there is currently a 1-2-month wait to see a neurosurgeon for any issue unless it is life-threatening." 

"Thus, they can't see me locally until October 15th - nearly one month from the accident. Thus, I am going to need to travel to Louisville, unless my attorney can find one locally through their connections."

I then reassured her that really, it's not that serious! 😂

And that I had no intention of including the healthcare system in my bodily injury claim - it's not that big of a deal!

As long as all the injuries are now documented correctly so that the insurance companies can't fight over it, then we're good!

I wanted to let them know, both to correct documentation for insurance purposes, as well as for quality improvement, reassuring them we would continue to use this hospital system and otherwise loved this hospital -  they took great care of my husband with stroke - I just thought they'd want to know what happened as a one-off in feedback.

She softened a little bit after that, and began talking to me like her colleague rather than an attorney, thank God - and then said as for the broken rib, it likely wasn't addressed because we don't wrap or treat broken ribs anymore.

Me: "I understand that now, but I didn't at the time - I only learned this after being referred to Orthopedics for the ankle and wrist, who explained it." 

"You all may know rib fractures aren't treated anymore as healthcare professionals and thus no need for discussion or instructions, but patients don't that until you tell us - we're not mind-readers, right?" 

"We also don't know what to do or not do, what activities we should avoid or not avoid, what signs to watch for worsening fracture, or expected healing time - again, until you tell us." 

"That's what I'm saying, this wasn't addressed at all in discussion OR my discharge instructions - and in fact, the doc said I didn't have a rib fracture when I asked, trying to tell him the brace was hurting my ribs badly!"  

"In fact, I was pretty sure I had a rib fracture, but I didn't know for sure until I read my own radiology report the next day myself, because nobody addressed it."

 

Patient Advocate: "Well, I guess that's because we were so focused on your back, but the diagnosis is mentioned in your paperwork, just not in your after-care instructions."

 

Me: "I get that, I totally understand and appreciate that - and yet there's a difference between what healthcare professionals assume is the most painful injury versus actual patient pain experience, right? What the patient is trying to tell you is still important." 

"My ribs hurt worse than my back, I tried to tell them that, especially after they put the brace on, but the doc said I didn't have a rib fracture." 

"And again, although you all may know rib fractures receive no treatment anymore, the patients don't know that until you tell them - you have to tell us and/or put it in the discharge instructions about what to do/not do, healing time, etc.. Does that make sense?"

 

Patient Advocate: "Absolutely, it does - I'll agree with you on that. Just because we know ribs aren't treated anymore doesn't mean the patient does, and you all definitely need to know that it could take up to 6 months to heal and not to lift anything over 5 pounds if you can help it. We could probably do better about communicating that, so I've notated that." 

 

Me: "That's the only suggestion for improvement I have. The rest of this, let's chalk up to miscommunication, because I mean, I could've misheard him, I was in pain. Well, that issue, and then there's the missing toradol shot I never received." 

"So ... when I first got there, I asked them to try everything before opioids first, because narcotics make me vomit.  So in addition to the basic Tylenol I asked for, the doctor said he would order a toradol shot, but it never arrived." 

"In fact, no one entered my room at all after the shift change at 11 p.m. After another 1-1/2 hours, I hobbled out to go to the bathroom by myself and asked the nurse about the toradol shot." 

"I was afraid to even do that because though the ER wasn't busy, I know there are patients there with worse problems -  but at the same time, it was now 2 hours later - 5 hours since entry to the ER -  so the Tylenol had worn off and the pain was really ramping up." 

"That is when the nurse told me the toradol shot was not ordered and she was having trouble reaching the doctor." 

"She said he "kept disappearing' and it was starting to piss her off. She literally said 'I don't know where he's going, watching football for all I know, but I have been unable to reach him. He's around here somewhere, just not responding to my texts and calls about you or any other patients.' 

"Then she said would find someone to just go ahead and order opioids. She was more frustrated than I was! 😂" 

"I mean, we're trying to keep people off opioids because of the risks, right? So here's myself and the nurse trying to do just that, but he forgets to order the toradol  shot entirely until hours later, and we're now at opioid level of pain." 

Then she said she notated that and would check into that with the nurse to see about that, she hadn't checked with her yet and there was no mention of a toradol shot anywhere.

I said "That's because he forgot to order it. So there's no documentation of it, but if you ask that nurse, she will confirm that she tried to contact the doctor about it later."

Then, I again reassured her that I had no intention of including the hospital on the bodily injury suit, and I'm not mad, I just thought they'd want to know - I would, if it were my hospital, for quality improvement purposes.

It's all good - whew, what a stressful week, though, right?

And yet I'm still handling it all with a smile and a joke, for the most part, providers and staff have actually commended me on my kindness and sense of humor through it all.

However, there's one exception - don't be trying to gaslight me or make your own documented medical mistakes MY fault, now, just to cover your asses, People -  I don't take well to that - AND there's no need for you do do that!

Because again, I don't plan on suing anyone in healthcare - we all make mistakes or misspeak or miscommunication. 

There was no real harm done - and as long as my injuries are now documented correctly for my auto insurance to cover now, and we learned from it all, then I'm happy. 🙂

I'm not a very litigious person (though perhaps I should have previously in life) -  and I don't plan on becoming one now 😂.

So the only planned litigation I have is a bodily-injury attorney to mediate a settlement with my insurance company for an accident that has been deemed 100% the other driver's fault- period.