After leaving port on family cruise meant to celebrate her in-law’s anniversary, Teri Dreher’s father-in-law suffered a fainting spell outside Beliz. He had never fainted before but had suffered from a small pulmonary embolism some months back and was treated. He saw medic on the ship. Although the ship’s clinic was nice, it lacked diagnostic equipment found in hospitals. The exam missed signs of a massive blood clot in his system. The next morning, Dreher found him swollen and turning purple from the waist down. As an intensive care nurse, she realized this was a medical emergency; his organs were not getting blood. After being transported to a hospital in Belize, which lacked even a working ultrasound machine, where he nearly died before he was transferred to the US. Throughout his dealings with medical staff and treatment, had Dreher had not stood up to his medical professionals, he would not have survived.
Her experience with her father-in-law just reinforced her belief that “it is a wise consumer that questions everything. It is so important for people to stand up and advocate for the patient.” She questioned what people do who don’t have a nurse or doctor in the family and realized that, without an advocate to intently HEAR what the staff is saying and question their decisions, people needlessly die. “There is a growing awareness that modern healthcare can be overwhelming and the statistics can be alarming,” she said. “Annually, 44,000 die of medically avoidable accidents.” She could no longer stand on the sidelines as an observer of medical negligence. This series of events – and having a number of strong contacts and having done a lot of research, led to her decision to create NorthShore Patient Advocates.
The oldest of nine children, Dreher was raised in a family that moved often due to her family being in the military. In addition to being a hospital and intensive care nurse for 38 years, she has volunteered a number of times to help the less fortunate in Africa. She also founded two nonprofits and worked as part of international teams in the Ukraine and elsewhere. Her passion is helping people.
As evidenced in a 1999 study that rocked the hospital industry, called “To err is human,” there is a growing awareness that people are in over their heads when it comes to health care issues. She cited the example of people not understanding the difference between entering a hospital “for observation” rather than being “admitted.” If someone is merely under observation, they may find themselves stuck with a hefty medical bill, whereas if they are admitted and stay more than three days, insurance will cover the expenses. Family members are urged to find out whether the patient is being admitted or is just “under observation.”
Also, “30 percent of those going to hospitals today will suffer some sort of adverse medical outcome, whether it is developing an allergic reaction to a medication, having the wrong body part operated on, a surgical complication, a fall or other incident,” she said. “Those are the kinds of things being seen over again.” Many need skilled care but lack the personal funds to pay for it or their benefits run out.
A lot of things are scary out there today.” A lot of germs in hospitals are hidden as not everyone is tested for infections. Solutions can be as simple as making sure doctors and nurses wash their hands before and after seeing a patient. Also, a changing healthcare model is taking place right now, which leads to fragmentation of care. Electronic healthcare charting is time consuming and detracts from patient care. Approximately six to eight hours of every shift winds up being spent working on electronic charting. This becomes frustrating to medical professionals and dangerous for patients. A number of other changes “are being instituted under the umbrella of patient safety, but – in actuality – are taking medical professionals away from the patient’s bedside. There is no replacement for that bedside care,” said Dreher.
Among the other changes taking place are the concept of concierge medicine and the prevalence of hospitalists assigned to patients. These changes can have consequences. Concierge medicine is more of an old-fashioned model but is expensive as individuals pay for the privilege to access them. Hospitalists are doctors hired by hospitals to see patients only during their hospital stay. Often they are paid less than nurses, but get a lot of benefits, yet they often have less allegiance to patients. Communication often suffers. In addition, financial constraints due to the Affordable Care Act (ACA) are trickier and impact all aspects of the healthcare continuum. Costs get passed on to consumers. Dreher stressed that with all the complications that have taken place over the past decade or more, the American healthcare system cannot financially sustain itself. The problems are too big.
As a result of all the changes taking place, as well as due to the lack of time professionals have to provide quality patient education, emotional support and care management that used to exist, the field of patient advocacy has quickly emerged and is growing. Patient advocates act like one’s personal family nurse. Nurses, often considered the most trusted professionals, make it all about the patient and love people.
“Plan ahead. Have a family meeting,” said Dreher. Advocates can be a family member, but consider “someone who has the heart, the time and the communication skills for it. You may not want someone who is too aggressive. Rudeness does not work well; it is a relational process and requires good communications. Talk out some of the details beforehand, like forms of life support. It’s good to know what the final days of a family member should look like” according to their wishes. “You, as their advocate, are there to support their choices.”
Advocates speak on your behalf when you are impaired and have been shown to reduce medical errors. No one remembers everything when they are sick or are in pain – like a medical or surgical history. That is where the advocate comes in. Treatment plans and medications, especially, may be misunderstood. Question the information provided if you are not certain what it means.
Dreher advises before a crisis happens, know family medical histories and write down questions for the doctor before a visit. Also, know all the medications you are on and check out www.drugs.com to avoid possible adverse interactions. The National Institutes of Health (NIH) provides unbiased, reliable medical information, as does www.cancer.org . She warns, however, “Be careful about the sites you Google and be particularly wary of information provided on sites or publications with paid ads. Disease websites are usually reliable.” Know what your medications do and, when seeing the doctor, be respectful of his time. “Speak up when you don’t understand something, but be polite and/or ask to talk to a nurse. Be prepared with your questions. Pay attention and ask for clarification when you don’t understand but try not to take up more than five minutes of the doctor’s time. Keep records, ideally in a journal so you can write down questions as you think of them and then can remember to ask them. Write the answers down near the questions.”
The time is right for patient advocacy. It is a service that is really needed, whether that advocate is a nurse or a family member or someone else. “Choosing the right advocate depends on patient needs,” she added. “Prevention is the key to preventing a health care crisis through education, empowerment, alternative therapies and health improvement. I try to avoid train wrecks and love to prevent problems.” She welcomes inquiries and provides free advice on cases all the time.
“Advocacy is the purest form of nursing that there is and this is the most rewarding job I’ve ever had,” said Dreher. “It’s basically is a safety net for patients and is extremely rewarding.”