Hospitals

Author Beware: Doctors Cannot Do Everything

/ Jordyn Redwood / 3 Comments

I was recently reading a YA novel (that I did really enjoy BTW) when I came across this passage. For a quick background, this young girl has just woken up screaming after being involved in a car accident so it’s presumed she has a head injury.

The passage is as follows from the novel:

The room fills up with people. Two nurses and a doctor appear as quickly as if I’d pushed the little red call button on my bed. 

“Sophie, I’m Dr. Langstaff. You’re in a safe place and I’m here to help you.” The doctor holds a syringe and a container, measuring out a clear liquid. “I’m going to give you some medicine to calm you down and help you sleep.” He inserts the syringe so the medicine flows into my IV. It drains the screams right out of me, like he’s pulled the plug on my lungs.

Interestingly, there are quite a few problems with this small passage.

1. There is a process to giving medications in the hospital. The doctor orders the medication, the pharmacy double checks and approves the dosage, and the nurse draws it up and gives it to the patient. This patient is on a medical surgical floor— this is the process that would take place.

2. Doctors generally don’t have access to sedatives or narcotics. There are only a few areas in the hospital where a doctor would have direct access to these types of medications that they could pull themselves and that would be anesthesia. Narcotics are very tightly controlled. Doctors generally can’t even access narcotics or sedatives via the medication dispensing machines on the floor— even those medications that only they can give (such as perhaps Ketamine for a sedation). This is not the “old” days where a doctor carried around a stock of medications he could dispense. Nowadays, they likely can’t even access them.

3. Sedatives generally aren’t the first choice for a distressed patient.  I think for writers, this idea comes from watching too many bad television hospital dramas, but in real life is rarely done. The first step in handling a patient that first wakes up from a traumatic event is to orient them to where they are and what’s happened. Involve the family in helping them feel safe. If the distress continues, evaluate if there is a medical reason behind it. Is there some undiagnosed medical problem? Does she need a repeat scan of her head? It really is unusual that you can’t calm a person down— even one with a head injury. Patients are generally only given sedation if they become physically harmful to themselves or others. We do use sedation in some of these situations, but not as a first line and not as often as you might think and most likely not in the head injured patient.

What are some other things you’ve seen in books that aren’t accurate as far as a hospital setting goes?

VIP Patient Rooms: Are They Real?

/ Jordyn Redwood / Leave a comment

When most think of hospitals, we envision sterile environments with mediocre food and beds that lack the comfort of home. However, while watching an episode of The Resident, the concept of VIP rooms emerged.

In the scene, the hospital admits a wealthy donor and hospital board member to their VIP room. The space is decorated with lavish furnishings and a duvet cover to compete with those in most hotels today. However, the scene pales in comparison to the real accommodations some multi-millionaires experience in the US.

How the rich endure their hospital stay never crossed my mind before, but apparently, they receive five-star rooms with services that the average American can’t afford.

Some hospitals cater to the those with vast amounts of money, the famous Hollywood crowd or politicians and diplomats who live in the US and abroad.

Luxury three-bedroom, two bath suites, beautiful living and dining areas with sweeping views of the city await them when admitted. Kate Hudson, Victoria Beckham and the Kardashian sisters have all experienced the posh treatment when delivering their babies.

Not only are the furnishings top-notch, but the affluent patients receive meal delivery from private hospital chefs, their own personal doula, hair and nail services along with free bath robes or anything else their heart desires.

As for the average Joe, our wallets can’t afford the four thousand dollar a night stay.  Our rooms are less ornate. We get one clean bedroom, one small bathroom, mediocre food from the cafeteria and bland furnishings. No personal doula for us although, breast feeding centers and coaches are available.

The maternity suites are not the only area where the wealthy thrive. Even when emergencies strike, affluent patients often skip past the ER department and straight to luxury accommodations. Where an average patient will spend hours waiting, the rich fast-track their medical care, bypassing the conflicts assigned to the rest of us.

My father always used to say, “Money doesn’t buy happiness,” and I agree. However, having some cash might make a difference when faced with a hospital stay.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

HIPAA and Identity Thefts

/ Jordyn Redwood / Leave a comment

Did you know pediatric medical records are being targeted by identity thefts?

I recently attended a staff meeting where our hospital’s privacy officer gave a talk.

I’ve blogged a lot here about HIPAA. You can check out some of those posts below.

What he said that was interesting was that identity thefts are targeting pediatric medical records because they have all the info they need and are “clean” meaning no problems with credit.

Generally, a child’s credit score isn’t checked until they are 18 so the thieves have years and years to use their information for nefarious reasons. He recommended parents check their child’s credit rating every year to make sure their identity hadn’t been stolen.

Think he’s off target? Here’s a news article from March, 2011 that discusses exactly what he’s concerned about.

To read more about HIPAA pitfalls when writing fiction– check out the following links.

HIPAA and Law Enforcement

HIPAA Part I

HIPAA Part II

HIPAA Part III

Have you ever been the victim of identity theft?

The Challenge of Caregiving: Rob Harris (Part 1/2)

/ Jordyn Redwood / Leave a comment
I’m very honored to have Rob Harris here at Redwood’s Medical Edge today. He’s giving a first hand account of what it’s like when your loved one nearly meets death. Part 2 will be posted Wednesday.
Welcome, Rob.
7:24 a.m. The nurse tech entered our hospital room and took my wife’s vital signs. I was awake, dressed and ready to record her findings on my Excel spreadsheet. “Temp: 97.5; BP: 122/61, Pulse: 32,” she said as she turned to depart our room.
I looked up from my laptop, my fingers frozen over the keypad. “Excuse me,” I stopped her in her tracks. “You gave me an incorrect number. You said her heart rate is 32? Is the machine working properly?”
She returned and took my wife’s pulse manually. “It’s 45,” she announced. Again, she turned to leave.
“Could you please ask our nurse to come into the room,” I requested calmly, so as not to alarm my wife. My wife’s pulse rate under normal conditions is high, typically in the mid-to-upper 70’s. Being in the 30’s or even the 40’s was cause for alarm.
She didn’t move quickly enough for my liking. I strode past her and turned the corner. Once out of eyesight I raced to the nurses’ station and interrupted the nurse assigned to our room. She was debriefing the attending physician prior to beginning his rounds. I apologized for the intrusion and explained my concern. They followed me and went straight to my wife.
Thus began a day I will never forget. My wife had received her sixth cycle of chemotherapy for a leiomyosarcoma, a 4-hour dose of methotrexate administered via an IV-drip into her port the previous night. Up to that moment, no unusual symptoms appeared.
My caregiver role began and ended at that moment. It commenced by my alerting the doctor and nurse that I was gravely concerned about my wife’s medical condition. It ended as soon as the medical teams descended upon our room.
To use a sports vernacular, I was “benched.” I was immediately transitioned from caregiver to spectator. As anyone who has ever attended a sporting event in which they are loyal to the home team can attest, a spectator, or fan, can yell, scream, cheer and even insult. Much as they may beg to differ, they have no bearing on the final outcome of the game. In other words, they are powerless.
And so was I. Worse, I was alone. I was ignored. I was invisible.
A crash cart suddenly appeared in our doorway.
“Would someone please tell me what’s going on here? Why is this happening?” I inquired to no one individual in particular.
I didn’t want to bother the medical team, but as low as my wife’s pulse was at that moment, mine was definitely heading in the direct opposite direction. Externally, I remained calm. Internally…Jell-O!
“We need to move your wife to the cardiac care floor, the nurse informed me. “Pack your things. We’ll be going as soon as transportation arrives.”
I obeyed. I didn’t exactly feel useful, but I felt, in some small way, engaged in the process. Someone had acknowledged me. Someone gave me direction.
The doctors, three of them, exhibited a calm demeanor. This comforted me to some extent.
I wish someone would look my way and reassure me; talk to me, provide a morsel of encouragement, I thought to myself. Nothing came, not a nod, a wink, a slight smile or even a glance in my direction. I guess I was invisible after all.
Finally, the nurse spoke. “We’re taking your wife now. You can go with us if you’re all packed.”
“Can you tell me anything?” I begged. Nobody, including the nurse responded.
I understood. I felt like a child in a room full of adults. Caregivers and children are to be seen and not heard. The memories came flooding back. I knew my place. My wife is their only focus, as it should be. Again, I remained composed on the outside, but I was combusting internally as we passed another waiting crash cart in the hallway just outside her newly assigned room.
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Rob Harris is a seasoned/accredited Human Resources professional. He is the author of two books. The first, “We’re In This Together, A Caregiver’s Story” is scheduled for release in the Spring of 2012. The sequel, “We’re In This Together, A Caregiver’s Guide” will follow shortly thereafter. More importantly, he is a seasoned Caregiver. His wife is a two-time cancer survivor (Non-Hodgkin’s Lymphoma and a radiation-induced leiomyosarcoma).  He and his wife are the proud parents of two U.S. Army officers. Presently, his youngest son is protecting our country’s freedom in Afghanistan after previously being stationed in Iraq. His brother recently returned from his first deployment in Afghanistan.

How to Write a Hospital Scene: Amitha Knight

/ Jordyn Redwood / Leave a comment
As a doctor, I don’t like reading books or TV shows about doctors. Not because I’m jaded and think I’ve heard it all before (quite the contrary) but because often, it feels like the writers just haven’t done their research. I’m not talking about highly involved medical research—it’s the basics that can trip you up.
Here are a few questions to think about when writing a character’s hospital scene (please note that some of this is for US hospitals only).
1. Is your character on the right floor?
As many people know, hospitals are set up with different patients in different areas of the hospital. There are pediatric floors, adult floors, surgical floors, maternity floors, ICU’s, etc. Knowing where your character/patient would be placed in the hospital depends a lot on the type of hospital you’ve chosen for your story. Is it a small community hospital in a small town? Or a large teaching hospital in a major metropolitan area? The smaller the hospital, the fewer wards there will be (and often the really serious cases would quickly be sent over by ambulance to a bigger hospital). In larger hospitals, the ward will be more specialized so you shouldn’t expect to see mixing of patient types (i.e., adult surgery patients in a medical ICU ward).
Why does this matter? It has to do with your setting details. For example: If your character is in the ICU, he/she won’t see a lot of patients walking around with IV poles in their hands. And the rooms in maternity ward have more privacy than in an ICU setting. If your character is the doctor rather than the patient—they won’t be wandering around random hospital wards. Your medical intern isn’t going to be regularly wandering around the pediatric wards and playing with kids there.
2. Who will be taking care of your character/patient?
This can be confusing and again, depends a lot on the type of hospital in your story. Let’s say you choose a teaching hospital. Who will be taking care of your character? I’m going to focus on the different types of doctors and doctors-in-training because that’s what I know the most about.
Medical students: These are students in medical school. They have not yet yearned their MDs so they are not “doctors”. Medical students are often allowed to see the patient first and ask questions—but not in an emergency situation. They do not make medical decisions for your patients.
Residents and Interns: These people have graduated from medical school and thus are “doctors”. They see their own patients and make some medical decisions, but are still in training and run major decisions by an attending physician (see below). Interns are what residents are called when they are in their first year of residency. In some specialties, residents have to do a separate intern year at a different program before beginning their specialty training. That’s why the distinction is made.
Fellows: These are people who have finished their residency but are doing further specialization and are also overseen by an attending physician, though less closely than a resident.
Attending Physicians: An “attending” is the doctor who is ultimately in charge of your patient during their hospital stay. All major decisions will have to be run by him or her.
This hierarchy can make a huge difference to the believability of your story. For example—a medical student or an intern will not be in charge of breaking bad news to a patient unless they have forged some strong bond with your patient. This is generally the role of the attending physician. Likewise, the attending physician will not be doing “scut work” (tedious hospital work, ordering tests) unless they are in a hospital where they don’t have interns and residents around.
3. Which patient will your doctor characters see?
This is one of the reasons I can’t watch Grey’s Anatomy. If you are a surgery resident, you will not be delivering babies. If you wanted to do that, you would have done ob/gyn. If you are an ob/gyn resident, you will not be taking care of babies in the neonatal ICU. If you wanted to that, you would have done pediatrics. And if you are a pediatric resident, you will not be doing surgeries. Please, get it right! Your doctor characters really can’t do it all!
Originally posted to the Guide to Literary Agents Blog. Reposted with author permission.

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 Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/.