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Chronic Illness Q&A with Dr. B.

Dr. Larry Berkelhammer

Dr. Larry Berkelhammer

This question & answer column is for people living with chronic health challenges and their family caregivers, who want to learn to increase the odds of improving their health by learning to live with mastery & wellbeing.

I invite you to post your questions in the comments box below. When I get a certain number of related questions, I pick one that covers them all and I answer that one.

I post to this blog three times per week. Monday posts are relevant published articles. Wednesday posts are interviews—mostly video. Friday posts consist of questions about living better with chronic health challenges, and my answers to them.

Here is this week’s question:

THIS WEEK’S QUESTION:  In the medical self-efficacy chapter of your book, In Your Own Hands, you said that it’s really important to have someone in the patient’s room all the time when you are a patient in the hospital. But, can that be avoided by going to one of the best hospitals in the country? My husband is scheduled for surgery at Duke; since they are rated so high, I imagine there are fewer things to watch out for there.

ANSWER:   Even in the world’s best hospitals, and yes, Duke is one of them, patients need to learn how to advocate for themselves or get family members to learn how to do it. Alternatively, professional advocates are available for hire.

A friend of mine recently had vascular surgery performed at a very fine, high-volume hospital that specializes in cardiovascular procedures. His post-op pain was not controlled at all, until they finally discovered that the epidural catheter had not been placed in the epidural space and had been delivering the analgesic medication where it could do no good. It had been put in by a resident, but the top hospitals in the country all use residents. The residents are closely supervised by the anesthesia attending, but mistakes are made.  Despite being a retired surgeon, he didn’t think to ask the attending to do it.

When my wife had a colectomy for early-stage colon cancer a few months ago, I asked the anesthesiology attending if she would do the intubation and the epidural. She told me that because it was a teaching hospital, the resident would do those procedures. We bargained and I agreed to allow the resident to intubate my wife provided she (the attending) put in the epidural.  Esophageal intubations are not unusual, but I reasoned that if that were to occur, at least it would be discovered right away thanks to monitoring. 

All kinds of mistakes are made even by the most experienced senior attendings and senior nurses. Many new systems have improved safety, such as bar coding. But as humans, we all make mistakes.

By having someone in the patient’s room 24/7, many of these mistakes can be avoided or at least caught before serious harm is done. I was in my wife’s room round-the-clock for the three days she was in, and not one mistake was made. However, nurses and nurse assistants are even more careful than usual when they know they are being watched by an advocate.

If you are scheduled for surgery and an inpatient stay, if no family member or close friend is able to advocate for you, hire a professional advocate—think of it as insurance.

This website is offered as a free public service, supplying information that has been found helpful to certain people living with chronic health challenges. No treatment is offered on this website. The advice is general, and may or may not apply to your individual situation, and is not a substitute for psychotherapy or medical treatment.

What questions do you have about how to live better with chronic health challenges that are related to the relationship between states of mind and health? 

Just scroll down and type your question in the comment box. I will post a reply to your comment, but your question may not appear in this column. 

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