Medical Competency and Accountability

Take control of the family's health care. Now, more than ever, you need to be clear about what the human body needs, and about who is taking care of your family. Read up on health care, and find out which tests, shots, examinations and care are necessary for you and your children. Find out how to make your home and yard safe. Make sure your home is clearly marked so that ambulance drivers can find you. Teach your children how to dial 9-1-1 and that they should never call 9-1-1 unless they need help. If you call for help, find out when help will arrive. If it doesn't arrive at that time, call again. Also call again if the patient's condition worsens (ask the dispatcher to upgrade the priority of your call).

Research emergency services. Find out if local ambulances are capable of handling babies and children (i.e. child-size equipment, specialized pediatric training, car seats). What kind of training do rescue squad personnel have? Are dispatch operators trained to give you pre-arrival first-aid guidance, or do they just call an ambulance? What is a typical emergency response time and to which hospital are you sent? Are EMTs certified in advanced life support? How many are assigned to one ambulance? Are ambulances equipped for resuscitation, immobilization, oxygen delivery, communications with the hospital, defibrillator, obstetrics delivery and intravenous solutions?

Research your hospital. Investigate whether your hospital has the latest information on drug and radiation dosages for children. Is the emergency room equipped for babies and small children (with child-size equipment and pediatric staff on call)? Does your hospital's radiologist allow you to stay with your baby or young child while exams are being done? You also should know how to reach the emergency room. If you or your child must have a procedure done, make sure that your hospital and doctor have effectively done the procedure many times.

Mark the part of your body that is to be operated on. It's become fodder for many jokes, but it might be a good idea to have your doctor or surgeon mark the part of your body (or your child's body) is to be operated on -- and then make sure the whole health team agrees on what's to be done. In extending this advice to the public, the Joint Commission on Accreditation of Healthcare Organizations noted in late 2001 that operations on the wrong body part are not unheard of (150 cases within 5 years, and increasing). If you're worried about offending, you can do all of this with gentleness and humor -- while still making everything clear to everyone.

Make sure your child is properly identified with an identification bracelet that lists name, allergies and blood type. Make sure medical staff always check the bracelet before administering medication, operating or doing any other medical procedure such as drawing blood.

Insist that everyone visiting health care facilities wash their hands. Hospitals and doctors' offices are the best place to run into germs, bacteria and viruses. A study from the Northwestern University Medical School in Chicago found that three of 10 upholstered seats in hospital rooms were infected with drug-resistant bacteria, and another study, from the Memorial Sloan-Kettering Cancer Center in New York, said that one outbreak of rotavirus came from communal toys in the playroom. Make sure everyone washes their hands with soap and warm water frequently and thoroughly. Reconsider whether you want your children to play with toys in doctors' offices and hospitals. Never let your children play on the floor or take their socks and shoes off. Never let them put their face or mouth on anything. Whenever possible, get medical care on an outpatient basis. And make sure that all medical personnel have washed their hands before touching your child. Don't worry about offending the doctor -- a good doctor won't take offense at a valid concern. Many illnesses are passed on because people forgot to wash.

Make sure the medical staff members are using the appropriate size of equipment. Double-check the size with medical professionals, and if you have any doubts or questions, pursue them. Using the wrong-size equipment (such as adult-size equipment on a child) can give incorrect readings, leading to unnecessary or dangerous treatment. It also can cause your child unnecessary discomfort or risk.

Take doubts seriously. Is your doctor abrupt, uncaring, sloppy, too rushed to listen, or dismissive of your concerns? Do your phone calls go unanswered -- even during an emergency? Is your doctor great but his/her staff a problem? Do you and your doctor differ on parenting philosophies? Does your doctor speak or behave inappropriately, aggressively, defensively, rudely or condescendingly in front of you or a loved one? Do you have doubts about the advice you're getting? Do you not think that you or a loved one is getting adequate attention in a hospital? If you, your spouse or partner, or your child ever has doubts about your doctor or mental health professional (or about any of the staff involved), take the doubts seriously -- even if, especially if one of you is about to go into surgery. There are a multitude of health professionals to choose from, and your instincts might be telling you something's amiss. If your doctor tells you something that doesn't mesh with your experience or your knowledge of your child, press for answers or get a second opinion. Don't dismiss your child's fears -- a child often can sense things better than can an adult. Backing away from a professional who makes you or your child feel uncomfortable could save a life.

Ask questions, discuss conflicts, and be ready to make decisions. If you have questions or concerns about anything (how you feel, how you're being treated, your symptoms, concerns, fears, prescriptions, drug interactions or side effects, operations and alternatives, costs of treatments or your insurance situation), speak up. Don't be shy about asking the things you need to know. Your doctor can't help you if you don't talk. If something doesn't seem right, ask about it. If your doctor brushes you off, press for answers or get a second opinion. If the side effects of a prescription seem excessive or not manageable, ask for alternatives. Find out what your doctor trusts (drugs versus surgery, for example) so that you can make intelligent decisions. Women are still often discouraged from being assertive, but it's important that you are clear on what's happening to your child.

Don't be afraid to ask for proof of credentials. Remember: This is your health -- and your child's health -- we're talking about. You should feel confident that your doctor has the proper credentials, abilities and bedside manner. Remember that an Internet site can be written by anyone. If your doctor won't provide you with proof of credentials, won't let you look closely at the credentials or seems unhappy about your questions, ask yourself why.

Make a list of everything you want to ask BEFORE you go. That way, you won't forget anything. When taking your child for immunizations, make sure you have your child's updated records with you. Take a notebook with you to write down questions, concerns, and instructions.

Get your doctor's attention. The doctor's eyes might be open, and they might even be looking at you when you're talking, but chances are it's been a long day, you're the 47th patient, and the doctor is still thinking about the 46th one ... Make sure your doctor is listening. Ask questions. Correct wrong statements. Don't take it for granted that "the doctor would have thought of that." If your situation is complicated or the story is lengthy, take time to write it all down, as objectively, succinctly and thoroughly as possible. Put it in chronological order, and divide it into logical sections so that information can be located quickly. Write down who you saw, what they said, what worked, what didn't, the dates, times, diagnoses, poor reactions to medications, or anything else related to the case. When you go to the doctor, take a copy of your story with you, make sure your doctor reads it, and make sure a copy goes in your file. Keep it updated for the next time you go. Even a caring, responsible doctor can't possibly keep track of all critical information relative to all patients. Don't leave your health -- or the health of a loved one -- to your doctor's memory.

"By the way..." A doctor mentioned to us that he often found out what was really going on when the patient stopped at the door to casually say, "By the way, doc...". So if you're on the way out, and you think of something you want to ask, go ahead and ask. Don't avoid asking just because you feel pressured to leave. If your doctor becomes impatient with you, consider finding another doctor.

Get another opinion. If you don't feel comfortable with what you're hearing, or with how you're being treated, don't be afraid to get another opinion. If you're about to have surgery, consider checking the diagnosis with another doctor (in January, 2003, a woman lost both breasts to surgery after she was incorrectly diagnosed with an aggressive form of breast cancer. The lab had mixed up her biopsy results with another woman's.) If your doctor seems reluctant to hear you out, or to provide you with other names or information, ask why.

Get the results. If you get tests done, make sure you hear the results. Don't allow your doctor to tell you, "If you don't hear from me, that's good news." Your doctor might forget about you, go on vacation or get killed in a car wreck. If you don't hear, call the doctor's office and find out.

Read the prescription. If your doctor writes out a prescription, make sure you can read it. If you can't, have the doctor rewrite it so you can (if you can't read it, the pharmacist might not be able to read it, either). Make sure you know what you or your child is supposed to be taking, how much to take, when to take it, any potential side effects, and what you or the child should avoid ingesting or doing while taking it. Write everything down so you don't get confused or forget. When you get the prescription filled, check with the pharmacist to make sure you have the right drug. If the medication doesn't seem to be working for you as promised, tell your doctor. If your child is admitted to a hospital, make sure that when medication (prescription and over-the-counter) is given to your child by someone else, it's handled properly and based on the child's exact weight. A study from the Children's Hospital in Boston found that dangerous drug errors took place three times more often in pediatric situations than in hospitals for adults.

Give your doctor all the information. Make sure your doctor knows about any allergies to medication or adverse reactions you've had. Also tell him/her about other prescriptions (bring the bottles with you, so that there's no confusion over names), over-the-counter medications, herbal supplements, and dietary supplements or products. Mention any medical conditions you have or have had, and don't tell yourself, "I don't need to mention that." Let the doctor decide what isn't important.

Bring support with you, and use the hospital support system. If you need to have surgery, make sure you have friends or family with you to hear about the procedure, to be there during the procedure, to help when you wake up and to help get you home. That person will hear things you haven't heard. You also might be groggy or distracted when instructions are given, so make sure everything is written down for you. Additionally, the hospital's social worker can help you coordinate whatever follow-up care is needed and can also help you locate support groups and financial assistance.

Use only one pharmacy. Use only one pharmacy to fill your prescriptions. Pharmacists are trained to watch for prescription problems and conflicts between medications, but not having all of the information makes it more difficult. (And if your health plan allows for it, see only one physician for general health issues.) Ask your pharmacist to confirm the medication and the dosage to make sure it jives with what your doctor told you. Again, if the medication doesn't seem to be working for you as promised, tell your doctor.

Take care with Internet sites. Remember that Internet information can be written by anyone -- even the teen next door. Visit several sites, and find out who wrote the information. What is the original source of the information you're reading? How current is the information? Is the information fact-based or it is subjective? Is the site commercial (trying to sell you products or services)? Be skeptical of sites that aren't well-known or government-sponsored. Are you being asked for personal information? If so, what will be done with it? Back up the information you find with input from your own health professional.

If your doctor's medical license has been suspended or revoked, consider finding another doctor. It takes a lot for a license to be suspended, so take it seriously. If your doctor's being sued, however, that might or might not indicate a problem. Try to find out the details and pay attention to the care you're getting. People who are being sued sometimes become impatient, bitter, overwhelmed or distracted.