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With our aging population continuing to expand, there may be a time soon that you too will have an encounter with a hospital. Having a basic understanding of how hospitals function is the key to maximizing restoration of health during a hospital stay. Taking the time to learn some basic concepts will help prevent a great deal of frustration when this encounter does take place. Hospitals are somewhat of a paradox. Walk through any given hospital and you will see signs of the seemingly lavish spending intermingled with stories of unavoidable constraints. What follows is a simplification of hospital structure in Ontario, Canada.
Local politicians, MP's and MPP's (Members of Parliament, Ontario Members of Provincial Parliament), do not run hospitals nor are they run by OHIP (Ontario Health Insurance Plan) employees as is thought to be the case sometimes. There was a time when mid-sized city hospitals were run by nuns and part-time administrative physicians. This process has evolved over the years, and today our local hospitals are run by large management teams. You will rarely see or encounter these people during your stay. In a nutshell, this team draws professional full-time salaries and oversees how the money is spent and which services the community will receive. They hire nurses, technicians, cleaners, managers, professional fundraisers, etc., and a few physicians. A yearly budget for funding which in our neck of the woods measures in hundreds of millions of dollars is submitted to the Ontario Ministry of Health for approval. After reviews, negotiations and such, the money flows back to the managers who use the money to run the hospital. A group of volunteers from the community form the Board of Governors. They spend a great deal of their time to help ensure that the needs of the community are being met. Another group of volunteers help run the hospitals. Volunteers can number in the hundreds and are crucial for the smooth operation of hospitals. The relationship that doctors have with hospitals is somewhat difficult to understand. You can think of doctors as independent contractors whose services are covered by OHIP and not by the hospital, but who choose to render their services in a given hospital. These services are not part of the yearly hospital budgets. Along a similar line, they are not part of the operating structures and have declining input into the running of things. Doctors working in hospitals full-time comprise less than 5% of the hospital work force! This is a seeming contradiction to what the Hollywood image would have you believe. Doctors are becoming rarer sights in hospitals.
Survival depends on understanding the inner workings of hospitals. While visiting the emergency department you are not considered an in-patient until you are admitted. A survival tidbit is to bring a fully written or typed medical history with you and hand it to the emergency physician looking after you. It should include a synopsis of medications, names of specialists, tests and contact numbers. Also remember that hospitals are fully operational for only a few hours of the day. Many departments, supports staff, special tests, elective surgeries, operate between 8 a.m. and 3 p.m. Outside of these hours, it is difficult to accomplish things, despite appearances that things "look" open.
If you are very ill, then you will be admitted. For that to happen, a physician must be found to oversee your medical care. This person is known as the "MRP" (Most Responsible Physician). They write orders pertaining only to your medical care. You will also be assigned a primary nurse who will be responsible for overseeing your nursing care. The names of these people should be committed to memory at the first instance. MRP's tend to make rounds in a given pattern, an observation that may be of use to concerned relatives. The MRP's designate may see you instead, or a consultant may visit for a second opinion or treatment. Intensive care units and emergency are the only places where physicians are found regularly around the clock.
When things do not go smoothly, there is little to be gained in yelling at volunteers or nurses. They make easy targets because they seem to be hard at work, and in plain sight. Nurses, doctors and technicians cannot solve bad food, excessive parking fees, poor accommodation, broken phones, and other like problems. You are more likely to get some type of response by asking the operator to contact the on-call administrator for you. These individuals are keenly trained in the workings of the hospital and often implement the given policies.
Expect the first half of your admission to be devoted to finding you a hospital bed, while the rest of the time is relegated towards getting you out of that same bed. Sometimes, you may be discharged and require continued care. This essentially shifts you into the invisible virtual hospital which runs through a Community Care Access Centre (CCAC). They will be requested to provide ongoing nursing and home care while you recuperate. Your MRP no longer exists, and CCAC workers are faced with seeking another physician to oversee your care since the CCAC does not employ any physicians. I consider all complete transition of care events as weak links in the health care system full of frustrations and potential problems since the new strangers are not familiar with your health problems. The detailed notes that you keep regarding your own care are still your best insurance for maintaining continuity of care.
Finally, do not assume that your family doctor will receive news of your admission, testing or follow-up in a timely fashion despite everyone in hospitals telling you so. Things arrive by snail mail and take weeks to get there, if at all. Often the first we hear about your hospital encounter is when you walk into the office expecting particular follow-up promised by someone else on our behalf. Frustration on both parts is the norm especially if the procedure took place in a non-local hospital. Patience and keeping my fingers cross are starting to wear thin as a short-term survival strategy.
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