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As I'm in my 60s, I have elderly friends and relatives who have spent time in hospitals and rehab facilities. The patient needs to have an advocate who is informed of their situation and is present when the doctor makes their brief daily or weekly visit. I've seen decisions made, that contradicted the information in their "chart" such as exercise sessions for a person with a documented broken spine, treated as inviolable by the nurses and other clinical staff. Only the doctor can change the facts of the case.

What I suggest is that if you have a friend or relative visiting you, they should bring a "flip chart" -- the old fashioned 2 x 3 foot pad of paper -- and write down in huge letters the most important details of the case. Ask the doctor to help you fill it in.

Highly recommend reading Atul Gawande's "Checklist Manifesto" [0] if you are interested in the operational results of adding something like checklists to medical care.

Case in point: requiring everyone in the operating room to say their name, specialty and reason for the operation (and their part in it).

You might ask why the above is necessary?

Well:

- everyone is wearing a mask, cap and possibly glasses which makes them hard to recognize

- the patient is often draped in such a way that you can't tell who they are

- many Operating Rooms(ORs) look the same

- there are apparently COUNTLESS stories of medical personnel going into the wrong OR and not realizing until the surgery has started

Another fascinating point about checklists since the OP article mentions doctors vs nurses: checklists give nurses the power to challenge doctors. e.g. "Dr, I believe the next step on the checklist we agreed on is to do X".

If you have no checklist, the Dr can just say "No, we don't need that, I know what I'm doing. Shut up, Nurse!" (this is a real example from the book btw).

He also has an article comparing the Cheesecake Factory to health care that I also highly recommend [1]

0 - https://amzn.to/3KyLK1x

1 - https://www.newyorker.com/magazine/2012/08/13/big-med

Wow. Fascinating article. I am an engineer in a family that is otherwise purely medical (mom nurse, dad pediatrician, sister veterinarian).

Over the years I hear a lot of their pain points, and EMR's are consistently very painful for my boomer parents who are not tech savvy (my understanding is that it's not an age thing, though).

I have personal experience with pt. 8: Doctors know who's good, they just won't tell you. When I had a meniscectomy with poor results, none of the orthopedists I visited after the surgery would comment even lightly on the appropriateness of that procedure given my symptoms and MRI. This isn't different to other professions, where you generally have nothing to gain from badmouthing colleagues, but its incredibly painful that thousands of people are prevented from good care because of this meritocratic breakdown.

As a totally separate point-- this format of shadowing notes in incredibly compelling! I've been shadowing chemistry and biology wet-labs lately, and I wonder if making similar writeups would be interesting to others?

That’s super frustrating, your bad surgery. I’m sorry that happened. I don’t know, though, what would be gained by telling a patient they got crappy care.

Once it’s done, it’s done, that’s the medical reality you’re living in: it strikes me like saying “oh man if you had driven a sturdier car, then this crash might have hurt you less, wouldn’t that have been better?”

In medicine especially, who can truly know the counterfactual?

In my own work, when I’ve gossiped about somebody else’s decision-making or work product, I’ve often gone on to be humbled by learning that the other person had more context or different information than I did while judging in self-assured retrospect.

As far as “prevented from good care”—isn’t the alternative frequently no care at all? The Very Best surgeon still can only do the same number of surgeries.

Professional boards set minimum standards, and they run out practitioners who fall below. Even your bad doctor washed his hands and sterilized his tools: in that sense it’s still “good care” compared to yesteryear’s barber’s chair, rusty saw, shot of whiskey, and leather belt to bite on.

Not to get off on a whole thing. I appreciate your perspective and your strong written voice, and I’d definitely be interested in your shadowing write-ups!

Nurses know, too; they just can't tell you because they are not licensed to give medical advice.

Once, in a situation when we really wanted an opinion from a nurse who wouldn't give one, we finally asked, "If it was your daughter, what would you do?" With no hesitation, she told us exactly what she would do. She just couldn't tell us what we should do.

That phrasing has proven to be useful a time or two since then...

Reading this, it's not surprising why alternative medicine remains popular. Generally, the practitioner both acts like a human and treats their patient like a human. That doesn't appear to be the case in a conventional hospital.

Is 'Hospitalist' an American thing? I'm afraid the word grates on my European ears.

Yes, and the term didn't exist 30 years ago. It's a relatively recent thing, but very widespread now. https://en.wikipedia.org/wiki/Hospital_medicine

Hospitalist is a recognized medical speciality with their own national society and NUCC provider taxonomy code 208M00000X.

https://www.hospitalmedicine.org/about-shm/what-is-a-hospita...

Thanks, but that doesn't really answer my question. It demonstrates that it is a thing in America, but for it to be an exclusively American thing I would really need some confirmation that it is not widely used in other places. Cheers for whoever downvoted, would love to understand why asking a question gets a downvote?

It's widely used here state-side, yeah.

Never heard it in my part of America

I have, but only because my brother-in-law is one. If he weren't, I most likely wouldn't have heard of it either.