“The weapon of the advocate is the sword of the soldier, not the dagger of the assassin,” according to journalist and writer, Alexander Cockburn. The sword of the advocate, whether used for oneself or a loved one, may also end up opening doors that can benefit others. My work involves promoting the importance of family involvement in patient advocacy. But on occasion, I have needed to advocate for myself; I hope the results will help others as well. Two years ago, and again more recently, I was a patient in the same ambulatory surgical center for routine eye procedures. The first time I went twice for cataract surgery; the second time I returned twice for YAG laser capsulotomy to allow light to enter the thickened capsule holding the artificial lens, thereby restoring sharp vision. The procedures are common, and my surgeon is experienced at both. An ambulatory surgical center made good sense. No one wants to go to a hospital unless it is necessary – especially nowadays when fears of infection loom larger than ever. For the patient, the experience of the surgical center is not only a reflection of the skill of the surgeon. It is also a measure of care provided by the staff. And that means staff must be skilled, attentive and well trained. Based on my experience, training has been a problem at the center I visited. Let me explain. My first cataract procedure was textbook from start to finish. I left the surgical center feeling alert, well cared for, and optimistic about recovery. But the second visit did not end well. The surgery was fine. But I was discharged in a wheelchair, groggy, confused, and unable to stand, walk or understand directions. My husband needed help folding me like a ragdoll into our car. And once home, he needed assistance from neighbors to get me into the house. I laid on a couch for hours after, unable to sit upright or move around. Once I recovered, I contacted the surgical center to let them know something had gone wrong with discharge; I should never have been released in that condition. I was convinced I had been given too much of the sedation drug. And even if the dosage were correct, the recovery was not acceptable for discharge. Their initial response was blasé and dismissive. After getting nowhere with first the nurse and then the anesthesiologist, who made it clear he didn’t want to talk to me, I insisted on speaking with the director of the facility. That took some doing. But to her credit, she listened carefully as I described what happened to me, the safety risk involved, and the importance of staff training in patient discharge. It should not be a rote exercise with the mindless checking of a few boxes. It should be deliberate, thoughtful, and patient-centered. When I finished my story, she promised to follow up and improve the training program. I also told my surgeon about my discharge experience, as I thought he should know too. So, I was hopeful when I returned two years later for the YAG laser treatment. I checked in to the center, signed necessary papers, and waited to be called. It was a long wait, and while there, I couldn’t help overhearing another patient being checked in for the same procedure. She was receiving a detailed, easy-to-understand explanation of what to expect. I found it helpful and wondered why I hadn’t been told the same thing. When I asked about it, I was told the person who checked me in was new and didn’t know to do it. Another case of inadequate training at the same facility. I complained to the nurse manager, who appeared annoyed that she had to address my grievance. With little patience and no show of concern for my wellbeing, she curtly said the matter would be addressed. Talk about lack of bedside manner! And, again, I told my surgeon, who listened to my reiteration about the importance of staff training. When I went back for my second YAG procedure, the check-in process included a full explanation of what to expect. The nurse manager matter-of-factly asked if I had received proper “teaching” during the process, and my doctor told me he had sent an email about my previous experience and hoped things had gone better the second time. I thanked him for his support and said I hoped my calling attention to the need for better training carries over to benefit future patients at the facility. I recognize that finding time for staff training and making sure the training is effectively practiced are challenges in a busy clinical setting. But taking care of patients means that both goals must be met to ensure safety, quality, and best possible clinical outcomes. As one who speaks and writes regularly about patient advocacy, I am more comfortable than most when it comes to finding my voice and speaking up – professionally and constructively. It may not be so easy for others. The bottom line is that clinical staff have an obligation to make sure all patients are well cared for from the time they walk in the door until they are ready to leave. The Joint Commission’s 2021 Ambulatory Health Care National Patient Safety Goals address four critical areas of health care safety: patient identification, medication management, infection control, and prevention of medical errors. Based on my experience, two more areas are needed: patient communication and discharge protocols. In the meantime, I will keep my advocacy sword polished and ready, honoring the spirit of Alexander Cockburn who died at age 71 of cancer. I’d like to think he advocated for himself as long as he could until his death. Source
