Toddie Downs
According to the publication Statistical Abstract of the United States, more than 2.3 million children were admitted to hospitals nationwide in 2000. A family undergoes a significant amount of stress when their child is admitted to a hospital, whether this is the first admission for a routine procedure or the seventh or tenth admission for a child with a chronic illness or disability.
This stress can inadvertently be increased because of misunderstandings, miscommunications or missed communications between the parents and the child's physician or medical team. The good news is that most physicians and nurses want the parents to be a part of the child's medical team. After all, you know your child better than anyone. What follows are some recommendations to optimize your ability to advocate for your child during an admission to the hospital.
Know the Hierarchy
In virtually all hospitals, the person who provides the majority of hands-on care for your child and sees him the most is the nurse. Nurses generally work eight or twelve hour shifts, and when one shift ends, the incoming shift gets a report on all the patients over the last shift.
If your child is going to be in the hospital more than a few days, a primary nurse may be assigned to him. This means that whenever the primary nurse is on shift, she will be assigned to your child as one of her patients.
The number of doctors you will see depends on the type of hospital your child is in. In a small hospital, her pediatrician or family physician, and perhaps a physician from the hospital, will take charge of her care. In a large or "teaching" hospital, a resident physician, i.e. a beginning physician who is doing a four-year residency, will follow her stay. Her regular private physician will also be checking on her.
There may also be a "fellow" involved, a doctor who has completed his residency and is doing specialty work in a given area. And finally there is the attending physician who oversees the residents and fellows. This doctor may or may not be your child's doctor. When my son was hospitalized last summer, a nurse practitioner, nutritionist and surgical team also particpated in his care.
Your child may therefore be seen by anywhere from one or two to seven or eight doctors. To add to the confusion, many of these doctors may rotate to another part of the hospital at the end of the month, so there could be a whole new set of faces and names to memorize, depending on the timing of your child's admission and length of stay.
So with whom do you talk when you have a question or a concern? Start with the most accessible the nurse. If she does not know the answer to your question, she will forward the question on to the appropriate person. If you are not satisfied with the answer you receive or no response is forthcoming, move on up the hierarchy, keeping in mind that the people in question are likely to be very busy and may not be able to respond to you immediately.
Know the Routine
There are good times for talking to your child's doctor, and there are not-such-good times. Not-such-good times to talk with your doctor include when you see him walking down the hall or at the nurse's station writing in a chart. While your doctor wants to answer your questions and get your input, he is also caring for many patients at the same time, so his time is at a premium.
When your child is being admitted and you are meeting with the doctor for the first time is a good time to ask about the best time for her to answer questions as they come up or to discuss your child's health, hospitalization and treatments with you.
Some doctors may set up a designated time to meet with you; others may be more informal and offer to talk on an as-needed basis. Still others, especially in larger hospitals, may invite you to ask your questions during rounds.
If your child is in a hospital where physicians make rounds, this period is an excellent time to get an overview of how your child is doing and what the plans are for him. "Rounds" is the term used for the process by which the attending physician is brought up to date on the progress of all the children on her service. She will be joined by those people caring for your child, i.e. the residents, fellows, nurse practitioners and/or medical students. Normally the resident will review the child's medical chart and give the attending a report from the last twenty-four hours.
You are allowed to be present when the team is examing and discussing your child, and often will be given an opportunity to ask any questions you have or voice any concerns. Use discretion, however; while rounds may be an appropriate venue to ask clear, quick questions "How soon after surgery will my son be able to eat?" or "How long do you anticipate that she will need morphine for pain?" lengthier discussions should wait for another time.
For many families with working parents or other children, it may be logistically impossible to be present for rounds. If this is the case, you should make sure that the child's nurse is present when the team rounds on him, and that she conveys the information to you soon thereafter.
If you want to speak with the doctor about something that occurred during rounds, it is best to have your child's nurse page him and ask him for a time when he can meet with you to discuss issues. Keep a notebook handy to jot down your questions as they occur; nothing is more frustrating than finally getting to talk to your doctor and then remembering a topic you forgot to mention twenty minutes after the meeting.
Remember Who's the Patient
At all times you need to be cognizant of how your child is feeling and what she is picking up of the conversations going on around her. Sylvia Rimm, Ph.D., a child psychologist and clinical professor at Case Western Reserve University School of Medicine, recommends that when you are talking with the doctor, especially in the case of serious illness, the child should not be in the room while you collect information and ask questions. She states:
What the doctor says can be very alarming and frightening to children even when the outcome and procedures are relatively minor. Parents should then interpret to their children what will be happening. This is not a small issue since doctors are accustomed to speaking spontaneously. They are often in a hurry. Parents may need to say, "Could we talk about this in your office or another room or in the hallway?" Then be sure to go back in and comfort and explain to your child.
Dr. Rimm indicates that while parents may legitimately feel anxious, worried or sad during this time, it remains important for you to be honest, but as optimistic as possible when interpreting the doctor's comments to your child.
Offer Your Opinions
Remember, you know your child better than any of the professionals working with him. This makes you an integral part of the medical team. When my son needed surgery for an incisional hernia, my husband and I knew from prior procedures that he reacted very strongly to small doses of morphine. We made certain that we told both the surgeon and the anesthesiologist, and they were able to provide him with pain medication other than morphine, allowing him to wake up earlier with fewer after-effects.
Dr. Rimm suggests that by keeping a notebook, you can keep track of your child's behaviors, feelings, pains and symptoms. In this way, you can describe to the doctors what you have observed over time and give a truer picture than your child may be able to. She notes, "Children tend to respond to the doctor only about how they're feeling at the time of the visit. Also they tend to want to please the doctor by saying all is well unless they are feeling very sick at the moment the doctor is in the room."
You will also be able to help your physician by telling her of any pertinent medical history or preferences, such as reactions to different medications or difficulty sleeping when under stress. While some of this information may be considered medically non-essential, it is still essential for your child's comfort while in an unfamiliar environment. Along the same lines, if the hospital is not already doing this, do not be afraid to ask your nurse that interruptions for medications, blood draws, vital sign checks and other routines be consolidated or kept to a minimum.
Conclusion
You and your child's doctors and nurses are all on the same team; each of you is working to make your child's stay in the hospital as pleasant as possible under the circumstances. Your child's doctors and nurses are busy people who are juggling many tasks; it is as much your responsibility as theirs to speak up and advocate for your child when you see a need. Ultimately, your child will reap the benefits by having a medical team that is communicating effectively.
Toddie Downs writes on health topics. She lives with her family in Cleveland Heights, OH.
May not be reproduced in any format without written permission.
