When Your Loved One Is in the Hospital

If your loved one was taken to the Emergency Department (ED) for the first time and then admitted to the hospital, you may notice all the people coming and going from their room. It’s all kind of a blur because you can’t believe it’s happening in the first place, let alone track everyone’s names and roles.

Or maybe your person isn’t in the hospital, but they tell you casually that they saw this-or-that doctor the other day, although they can’t quite remember what that doctor said. “It’s fine,” they tell you, waving their hand, then ask what you’ve been up to.

In truth, there may be so many professionals involved that it can be hard to tell who is doing what. But treating each doctor as a completely separate expert is a mistake. As the expression goes, When everyone is in charge, no one is in charge.

Primary Care Physicians: The Bus Drivers

Ideally, the primary care physician is driving the bus. (That’s right; there can be so much going on with the situation that it would require a bus to carry them all.) If your loved one doesn’t have one, get one immediately; they are the equivalent of an entrance ticket to every other office. Do it now. You will not get a same-day appointment.

In a hospital, the bus driver may be a hospitalist, but after discharge from the hospital you will revisit the primary care physician to follow-up and reconcile any changes made as a result of the hospitalization.

For those of us who haven’t had major health issues we may not think of a primary care doctor as much more than the person who gives us our annual exam, if that. They keep an eye on our vitals, conduct pap smears and prostate checks, refer us to mammograms and colonoscopies, and order basic blood labs to be used as a benchmark for later in life (much later, hopefully). Or they may recommend weight loss, strength gain, vitamins, warn against diabetes, ask about genetic conditions, and the like.

For someone managing a disease—or several conditions—the primary care physician is vital, because they keep an eye on it all. They refer to specialists as issues arise, they look for potentially problematic interactions between medications prescribed by specialists, they ask how things are at home, they make referrals for in-home assessments and care, and generally sort through some of the complications built into our flawed health care system.

The Care Team

Specialists are doctors who focus on a particular organ, system, or disease. A nephrologist, for example, specializes in the kidneys; a cardiologist, the heart; a pulmonologist, the lungs; an oncologist, various types of cancer; a neurologist, the brain and nervous system; a gastroenterologist, the digestive system; a dermatologist, the skin—and the list goes on.

Of course when we talk about any one organ we must also recognize its connection to the others, which is not something that is always apparent when meeting with specialists who may defer to other specialists on some questions. This leaves the primary-care doctor—and you, because you have one patient, not 200—to track these connections to be sure the right questions are asked of the right people at the right times.

Easier said than done.

For each doctor, there may be at least one nurse or nurse practitioner. In a hospital setting, there will also be a social worker, aides, and physical, occupational, and respiratory therapists. There may also be administrators, caregivers, cooks, etc.

Look at these people closely. Ask them to write their names on the white board if they haven’t already. Write them down yourself if you’ll be calling the doctor’s office or nurses’ station at the hospital. Thank them for their time. Send them a card or treats. They will notice and feel seen, just as any of us would.

They are the family and like-family caregiver’s closest colleagues. And this journey would be miserable without them.