Richard and Karen, both in their early 50s, live in a suburb of Philadelphia. Karen was driving home from a visit with family when she went off the road in rural Pennsylvania. The nearest hospital identified a compression fracture in her spine, and sent her by ambulance to a major medical center in Philadelphia.

Karen could not recall what led to the accident, so to be safe it was decided to put her in a cardiac unit in case heart trouble had caused her to lose consciousness.

After she had been there for two or three days, her cousin Jake called Richard to ask how Karen was doing and how her care was going. Jake worked in the Infection Control department on another campus of the hospital where Karen was being treated.

Richard said, "She's okay, but I thought you worked for one of the top-tier hospitals! I can't believe some of problems she's running into."

Jake asked for particulars, and Richard said, "Here's one that should interest someone in Infection Control. Today a patient tech came in and Karen asked him if there was a way to redirect the air conditioning vent, because it was blowing on her. He had gloves on, and he took the cover off the AC unit. Then he lifted out a clump of debris and adjusted the vent. Guess what he did next?"


"He came over and started to test Karen's blood glucose level. She said, 'Aren't you going to change your gloves?' He shrugged, and said, 'If you want me to.'"

Jake groaned. Richard said, "That's not all!" and listed half a dozen other situations in which it seemed that Karen was paying more attention to getting good care than were the people treating her.

For example, Karen is an insulin-dependent diabetic, and nursing practices interfered with her ability to control her insulin appropriately. Additionally, people in the cardiac unit didn't know how to move her to avoid injuring her spine further.

"Listen, Richard," Jake said urgently. "Write down each of the problems she's run into. Then call the Patient Relations department and ask for a meeting. When so many things are off, that's the only way to get them resolved."

"Patient Relations?" Richard said skeptically. "What's that?"

"That's the department specifically set up to help patients when they can't get things to work right by dealing with the individual doctors and nurses directly."

"Never heard of them."

"The switchboard will put you through if you ask for the department by name."

Richard did as Jake recommended, and was astonished by the results. Within 90 minutes, the Patient Relations representative convened a meeting with the nurse manager of the floor where Karen was housed, a resident (a doctor early in his career employed by the hospital), an orthopedic specialist, an endocrinologist, Richard, and Karen - at Karen's bedside.

The Patient Relations representative had made sure that everyone had a copy of the list of problems that Richard had prepared. The list identified two problems with drug administration, a continuous problem with management of Karen's diabetes, examples of a continuous problem with keeping her spine appropriately immobilized, the concern about cleanliness described above, and other issues.

Richard said, "We explained that they had forbidden Karen from using her own blood sugar monitor to track her blood glucose levels. She was dependent on the hospital staff to come and measure. But they weren't testing at the appropriate times, so she was left to guess how much insulin to inject herself with from her insulin pump."

The endocrinologist asked, "Who's your regular endocrinologist?" Karen told him, and he said, "Oh! Well! You've got the best possible person in the area!" Comfortable that Karen had an appropriate care program, he said, "We can arrange for you to test your own blood sugar levels."

And in 15 seconds, Richard reports, the problem was resolved. The other topics were also speedily addressed. The whole meeting lasted only 15-20 minutes.

Karen was in the hospital for several more days. She and Richard agree that nurses checked on her more often than they had before the meeting, that hospital staff who came into the room were clearer about the procedures they needed to follow, and that no disturbing incidents occurred for the balance of her stay.

Even long afterwards, though, Karen remained troubled. "After Richard and I met with the patient advocate, my care changed, but not the care of others. At one point my roommate called several times needing help and they still did not come to help her. As soon as I rang for the nurse, one appeared. I told them she needed help, proving the squeaky wheel gets the grease."

Three key points stand out.

  1. It often seems to be a well-kept secret that that many hospitals have a department titled Patient Relations and/or representatives called patient advocates, patient ombudsmen, and the like. While not all hospitals have them, it is worth asking about when you are admitted.    
  2. These organizations may be very successful in addressing problems that the patient or family member has been unable to get resolved.    
  3. The fact that these departments can help you doesn't mean that the underlying problems that led to gaps in your care have been eliminated. That is, the next time you or a family member is in the hospital, it will still be important to be vigilant.