Who Cares For You?

Written by Bakersfield Magazine

As the United States’ population increased throughout the 20th century, and people flocked to metropolitan areas, the idea of a one-man operation traveling on horseback from house to house with a little black bag to administer care seemed, well, moot. Then, in the late 20th century, when hospitals and centralized physician offices popped up on every corner, receiving care in the same location as your next-door neighbor became the norm. But these weren’t the only changes in healthcare that would come to have a huge impact on the type of care we received. Throughout the 1970s, the increased specialization in medicine would change who was providing us with that care, in both a clinical and hospital setting. And for some, that’s been the most difficult pill to swallow.

To those people born in the last 40 years, having a team of doctors orchestrate their care isn’t unusual— it’s expected.

“Over the past 30 years, there has been a significant move toward specialization,” explained David Keith, COO of Kern Medical Center. “Sometimes down to the minute degree; in nursing, as well. And with that comes a higher level of care for patients and increased levels of accountability for physicians. Specialization was born out of a need for safety.”

In a hospital, it’s referred to as a multidisciplinary approach. A team of physicians, nurses, therapists, and technicians each handle specific parts of your care, be it respiratory; mobility; infection; or cardiac; and while they focus on their job, they’re still working together to get you well.

“Treatment is very holistic,” Keith continued. “It’s more than physicians and nurses. There are clinical experts, and the various support services that add to a patient’s resources while at the hospital. It’s quite a dynamic...and it’s very self-empowering for a patient.”

There is some hesitation for those over the age of 50; those that have spent most of their life under the care of one family physician, who, throughout the years, has performed any necessary procedures in his or her office. These folks’ hesitation comes from having to digest the sheer number of people who could potentially care for them during a hospital stay.

There’s no longer a floor nurse who monitors a patient while family doctors come in and out of the hospital between seeing other patients. There are admitting physicians, case managers, registered nurses, certified nurse assistants, dietitians, phlebotomists (to draw blood), physical therapists, and others. All of whom might enter a patient’s room any given day during the time that patient is checked into the hospital.

“The last thing we, or any hospital, want is for a patient to wonder who is taking care of them, to wonder why that person is in their room,” said Mitesh Patel, COO for Mercy Hospitals of Bakersfield.

“We want patients to feel like they’re a part of their team, too. They shouldn’t have to wonder what’s happening with their care.”

It’s one reason why all the hospitals in our area have programs in place to ensure all employees are greeting patients by introducing themselves and stating why they’re there, every time they enter a room.

This is not just for the benefit of the patient. As more and more family members are becoming involved in a loved one’s care, it’s become more prudent to clarify exactly how each member of a multidisciplinary team will help.

“The benefit of having the patient and their family know exactly who is caring for them opens discourse,” Patel explained. “They’ll have that group of experts available should any question arise.”

As a result, sons and daughters will know as much as they can about a parent’s course of treatment. And mothers and fathers, looking for as many sources of information as they can when it’s their child who’s ill, will find comfort. One of the fastest-growing information sources, the Internet, is furthering this trend.

Technology has allowed people to become active participants in their care. It used to be, you had to go to the doctor because there wasn’t very much information for someone to find.

So much medical information is available online today, that it’s commonplace to find a person searching their own ailments in addition to seeking the care of a physician. Or doing their own research before they even call the doctor. Of course, there are websites to trust and ones not to trust, and facts that need to be questioned, but the ability for a patient to discover so much about a disease today is unprecedented.

As patients are much more informed, they’re able to ask more questions, and thus become more involved in the “whys” of treatments. “Why is this the best treatment?” “Why will it help?” And since the Internet is widely-considered a young person’s tool, this puts more power in the hands of the majority of people visiting the hospital—those with young children and those with elderly parents; elderly parents who might be confused as to what is happening to them in the hospital because they’re confronted with so many people.

“A majority of patients will not see their general practitioner in the hospital,” explained Michele Shain, Director of Transformational Care at Bakersfield Memorial Hospital. “A primary care physician used to cover everything, but out of this increased specialization has come the need for hospitalists—physicians who care for a patient exclusively while they’re in the hospital.”

“A hospitalist may admit a patient to the hospital,” said Robin McNabb, Director of Critical Care Services at Memorial, “but they’ll call in a respiratory therapist, a registered dietitian, or even an occupational therapist if they feel the patient will benefit from those specialties.”

As McNabb explained, “a young person won’t know any different. They’ll think that’s the normal protocol. An older patient may become confused when they have to keep numerous doctors and nurses straight.”

“It’s a system that’s been around for a long time,” Shain said of the team approach to patient care. “Hospitals are still evolving.” So operational procedures that were once invisible to patients are now out in the open.

That’s where a family member, who understands how hospital stays work nowadays, and realizes that those specialists are both necessary and working for the good of the patient, can help clarify. They’re actively participating as a member of their loved one’s care team.

“For years, it’s taken a team to care properly for a patient,” said Martha Samora, VP of Ancillary Services at San Joaquin Community Hospital. “Only now, it’s become more visible to the patient and the family members.”

That’s partly to do with the way all hospital staff members are required to introduce themselves, and partly because patients understand that they can ask questions.

“It’s important for people to know that they should speak up while at a hospital,” Samora continued.

That’s how changes come about.

“Because change brought about new programs and collaboration, it’s afforded [us] the opportunity to develop relationships between departments.”

When all departments are working together, that’s when a person is going to see the best care. They have the entire hospital working for them. And if there is ever a concern in the level of care, anyone in the hospital can help find a way to help calm a patient’s or family member’s fears.

“They should ask questions about their care, about their treatment, and about their condition,” Samora added. “We want patients and families to be involved in all facets of care.”

Ultimately, the more involved a patient is in their care, the easier treatment will be because they’ll understand (there’s that magic word) what’s happening for them, and not just think these things are happening to them. Though there are generational differences in how healthcare is perceived, it doesn’t diminish the fact that there are so many more opportunities to stay informed of your own health, especially when you’re a patient in the hospital.

After all, everyone else in the hospital seems to be a part of your care—

you should be, too.

Article appeared in our 27-2 Issue - June 2010