As a physician, I have often been drawn into situations by family and friends in which I have served as an informal medical consultant about care and treatment issues. This has usually involved only telephone calls but, for immediate members of the family, hospital visits were commonly involved. On some occasions, I engaged in discussions with the treating physicians. On a small number of occasions, some of these conversations grew heated regarding the type and quality of care being given. One incident in particular stands out in my mind when a family member was clearly expressing a choice which was ignored by the treating physician who was interested. and insistent, on performing a procedure. He backed off reluctantly when I told him that my family member did not want the procedure and had been clearly stating that preference (see: Teaching Consumers to Say "No" to Physicians' Recommendations).
I am sure that my experience is not unusual. In my opinion, it is essential that family members provide close oversight over all aspects of healthcare delivery to avoid errors and improve the quality of care in their families. One blogger is referring to this phenomenon as Bring Your Own Physician (BYOMD). A recent article discussed the phenomenon (see: Going to the hospital? BYOMD):
Going to the hospital? BYOMD By now, most people know that hospitals are dangerous places, filled with medication errors, infections, poor communications and generally bad service. In case anyone needs to be convinced, the Institute of Medicine has just released a report on medication errors, indicating –among other things– that the rate of medication error is about 1 per patient per day! In the A Piece of Mind column in the July 12 JAMA, Dr. Frederick Hecht of San Francisco recounts the story about his daughter’s bout with leukemia four years ago and subsequent recovery. The story is about the extra burden of being a physician when a family member is ill –no blissful ignorance and wishful thinking for him....But as with any true story about illness and hospitalization, there is a subtext of error and danger: "Several days into my daughter’s treatment, I observed that one of the pills she was getting had changed, and it didn’t match anything she was supposed to be getting in the Physicians’ Desk Reference, which I already had at her bedside. It turned out that she was getting cis retinoic acid (Accutane) rather than all trans retinoic acid (ATRA) due to a pharmacy error....At another point, I noted a potentially life-threatening drug-induced hepatitis, which had been missed on her maintenance chemotherapy laboratory tests." In other words, his daughter could well have died if she hadn’t had her father, the doctor, looking after her. Don’t be lulled into trusting the hospital to take care of you. If you go to the hospital, try your best to take someone who knows what they are doing and isn’t afraid to speak up for you. If possible, BYOMD.
I fully understand that many families do not have ready access to a doctor friend or other skilled healthcare professional to provide advice when and where it is needed. I can also say with assurance that advice from family members about the care of hospital patients is frequently not appreciated by overworked hospital doctors and nurses. My only advice in these situations is to be courteous but firm when possible errors are spotted. This not only requires close surveillance by family members but, in many cases, some knowledge about the nature of the disease being treated as well as hospital procedures. Some of this knowledge can be obtain with deliberation and caution using quality web sites (see: Paging Dr. Google! We Are Waiting for a Second Opinion).
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