Real Talk About Hospital Stays with Monique Nugent, MD, MPH

Disclaimer: Unedited AI Transcript

Larry (00:07):

You are listening to specifically for Seniors, a podcast designed for a vibrant and diverse senior community. I'm your host, Dr. Larry Barsh. Join me in a lineup of experts as we discuss a wide variety of topics that will empower, inform, entertain, and inspire as we celebrate the richness and wisdom of this incredible stage of life.

Larry (00:40):

An unfortunate fact of life at our age is that sooner or later we are going to face a hospital admission. Whether it's due to an illness, an injury, or pain, we're gonna face one. And that can be confusing and frightening. Most of us need help in preparing for a hospital visit and once in the hospital. Learning how to navigate hospital care and advocate for ourselves is essential. So I called on Dr. Monique Nugent, author of Prescription for Admission, a doctor's guide for navigating the hospital, advocating for yourself, and having a better hospitalization. Dr. Nugent is a practicing hospitalist and associate director for the Division of Hospital Medicine at South Shore Hospital in Weymouth, Massachusetts. She completed her medical school and residency training at Loma Linda University Medical Center in Southern California, and her master in Public health at the Harvard School of Public Health. Welcome to specifically for seniors. Monique,

Dr. Nugent (02:02):

Thank you so much for having me. So I'm in my basement, so I'm trying the virtual background 'cause it's not the most appealing down here, but

Larry (02:12):

I'm not sure that everyone knows exactly what a hospitalist is. Could you describe your, your duties? Yes,

Dr. Nugent (02:20):

Yes. It's a, it's a question I usually start off answering before it's even asked. So I'm a hospitalist, which means that I am a board certified internist who sees patients only in the hospital. So years and years ago, the way that physicians used to practice was, I shouldn't say years and years ago, it was just up until the nineties that this became more popular. But the way that physicians used to practice was they would have their clinic and then the patients who were in the hospital, they would answer phone calls and run back and forth, see a patient do admissions, discharge, daily care, then run back to their clinic, and the nurses from the hospital were communicating with them in their clinic. And, and it was really kind of a catchall type of practice. What hospital medicine does is it acknowledges that the care of patients who were acutely sick, meaning something is going on right now, be it something new or an exacerbation of something chronic, but that care is a special type of practice.

Dr. Nugent (03:26):

There's a lot of things that are going on that can make the care of that person kind of different than what you would expect if you were saying always treating someone who has heart failure, like an acute exacerbation that's sick enough to come into the hospital, can't breathe, that's a very special type of patient. And by acknowledging that, that type of care is really more acute needs more attention needs, people always around the field of hospital medicine has really grown. And so what happened like in the eighties, early eighties, sorry, late eighties, early nineties, is that a young group of enterprising physicians would go out to clinics and say, Hey let's make this contractual deal. I will see your patients when they come into the hospital. You don't ever have to leave the clinic. I will take care of patients when they come into the hospital.

Dr. Nugent (04:19):

And that type of practice has really taken off hospitals like it because there's always somebody around. Finding the physician in their clinic or at home on off hours is not necessary. You have shifts of physicians who come in all, all the time. Nurses like it because again, people are available and immediately able to answer questions, answer to emergencies. And there's a lot more camaraderie built if you are working with these same sets of physicians over and over. Patients like it. Because now instead of waiting for your doctor to call you have someone who you couldn't immediately have a conversation with about what's happening. Some patients still kind of say I want my primary doctor to take care of me. And that's a different type of practice that's not really going on in a lot of places.

Dr. Nugent (05:11):

A lot more hospitals are, are really starting to depend on hospitalists and hospitals like it. Because hospitalists are always available to take patients into the emergency room, tend to emergencies, also discharge patients whenever they need to take patients in and out of the ICU. So it's a type of practice that's not just seen in internal medicine. You have pediatric hospitalists, you have a laborist who are obstetricians who just are in the hospital helping people give birth. You have acute care surgeons who are surgeons who see everything that goes into the on, in the hospital and comes in the emergency room. So it, it is a way of practicing that is a lot more efficient and acknowledges the special needs that go on in the hospital.

Larry (05:57):

And being a hospitalist, you are the one who has to face patients with anxiety about being in the hospital. Mm-Hmm. <Affirmative>.

Dr. Nugent (06:08):

Yeah. Yeah.

Larry (06:10):

How do, how do you advise these patients?

Dr. Nugent (06:13):

So the thing about hospital stays is that culturally it's not something we talk about preparing for. You know, nobody likes being sick or in the hospital. And we kind of put off that thought process. The only people who have conversations around preparing for the hospital are people who are caring for people who are ill. You know like parents who have chronically ill pa children or medically complicated children, people who are caring for their elder or a spouse with a complicated illness. Those are the people who are really looking for help kind of outside on their own. The rest of us kind of have this idea that like, I'll never get sick. I'll never need to be in the hospital. You know, unless you're pregnant and you look forward to being in the hospital. So the, the anxiety around hospitalizations comes from not knowing you can prepare for a hospital, say, and then feeling alone when you get into the hospital.

Dr. Nugent (07:10):

And then not realizing that the pace of things that happen in the hospital is very rapid, very fluid. And how do you respond to that if you don't have that capability to respond to it if you don't have a care partner? So the number one thing that I tell people is find a care partner. What is a care partner? A care partner is somebody who helps you make decisions about your healthcare, navigate your healthcare in general, who you trust and who's a source of comfort and knowledge, who can be an extra set of eyes, an extra set of ears in the hospital, ask questions, hear things, and help you move things along. And navigate a hospital stay. Being alone in the hospital is extremely difficult. And that's the first thing that I tell people is if you can find somebody who is your care partner. And for a lot of people, it's a, an adult child, it's their spouse, it you know, significant other in some way, but having an extra set of eyes and ears, an extra mouth to advocate for you, that is one of the biggest things you can do to alleviate some anxiety in about going to the hospital.

Larry (08:23):

I'm concerned, especially with older patients who may not have someone to advocate for them. Mm-Hmm. <Affirmative> especially those people with mild dementia. Mm-Hmm. <Affirmative> who have a real problem communicating. Is there someone in the hospital that can help them?

Dr. Nugent (08:45):

So it's kind of two pronged. I I would say if someone has the capability of preparing certain documents before they need to be in the hospital those documents can serve as your voice. If you're not able to speak for yourself specifically, I'm speaking about an advanced directive. And depending on the state that you live in, you may hear the word most or post form, which are mobile orders of life sustaining treatment or portable orders of life sustaining treatment. These are two documents. One, which is a legal document, the advanced directive. The other is a medical document, the pulse form that you can fill out to talk about what type of care you would want in cases of emergencies or towards the end of your life if you're not able to speak for yourself or make those decisions for yourself. Having those documents available serves as your voice, right.

Dr. Nugent (09:42):

And, and helps you to advocate for yourself in a way that you are able to put pen to paper and think of things. Now, I realize that that is really difficult. You just mentioned people with mild dementia because I'm asking people to prepare documents before they need them. Right? but, and the conversations are also hard and uncomfortable to have with your loved ones and with yourself, right? But if you can have those conversations and complete those documents with your legal representation for advanced directive or your primary care physician for the pulse form, those things are a big boon to you. The second part of your question is, is there someone in the hospital who you could advocate for you? So there's always, in every hospital, there should always be an office of patient advocacy. It may go by different names like patient engagement patient experience, something like that, right?

Dr. Nugent (10:44):

But hospitals are supposed to have this office, and this office is meant to be an extra voice for you. Or when you're saying, look, I'm having a hard time with getting my message across to this physician. I felt that the nurses were not responding to me in a timely manner. They're not understanding and respecting my boundaries. The, that office of Patient Advocacy, patient engagement, whatever it's called, is supposed to sit down with you, have a conversation, flush out where you think things are going wrong. And the great thing about these people is that they have the connections to know who to call next. Right? Who is the next person in line, who is a nurse manager for that floor, who is the director of X, y, and Z department? And then have a conversation with them and saying, Hey, this patient is really having a hard time with whatever is going on. How can we make a plan to help them feel more comfortable and ease some through this hospital stay?

Larry (11:48):

I'm, I'm pushing a little bit on patients with dementia because I've seen it in the hospital. Yes. Even, even with the office that's supposed to help that some of these people do not get the care they need.

Dr. Nugent (12:04):

Yes. I was, I was circling back to that. It, it is extremely difficult. You're a hundred percent spot on. If you are alone, you have nobody advocating for you. You don't have a care partner. Even if you have the documents for advanced directive in M form, that doesn't take away things like feeling that you're not being toileted fast enough feeling unsafe at night. With sundowning, it doesn't take those things away. It, it, it is extremely difficult for people who don't have the faculties for themselves to advocate for themselves. Right? this is where we do have to unfortunately expect that our healthcare team is able to start advocating for the patient within themselves. Hospitals have departments of ethics or ethics team, depending on how large a hospital is. Some hospitals do focus on elder care. There are different certifications that nurses and hospitals can get to say, Hey, we are an elder friendly facility.

Dr. Nugent (13:17):

The, excuse me, the bodies that govern hospitals and grade hospitals take this into account and will go into a hospital and say, what is your protocol for dementia and delirium patients? How often are you using restraints? So there are a lot of bodies outside of the hospital that are looking for caring for our elders. But if somebody has literally nobody and even those documents are not helpful, it does become incumbent on the people caring for them to look, to maintain someone's dignity and comfort. And that's where training nurses and hospitals to care for our elders, it comes into play. And we do have a lot of organizations who are looking at that and who do hold hospitals responsible for their care of elders.

Larry (14:18):

It, it, it's an extremely difficult problem. Let's talk about your book,

Dr. Nugent (14:26):

<Laugh>. Okay.

Larry (14:27):

Prescription for admission. I have read through this book, and I think it is a book that probably every older person should have. It's a guide. How can it, how can the book help people be prepared for an admission and how can they work through an admission once they're in the hospital?

Dr. Nugent (15:00):

Yeah. My aunt called it a manual. She and I thought that was really kind of spot on. The book is meant to be used. You're correct. Somebody asked me once if we had it in hard co cover. I said, no, because I want it rolled up into bags, taken with people, Ben back written on there are a few places for people to write down and practice things like practice making their medication lists and thought process around CPR and things like that. But I've really designed the book to be chronological to say, before I get to the hospital, what are things that I can do to prepare? And there are kind of simple things outside of those documents. So I spoke about things like knowing what your medication lists are or knowing where to get their medication list. Having contact information for your specialist, trying to go to a hospital that's familiar with care, right?

Dr. Nugent (15:54):

Because every hospital stay builds your story in that patient in that hospital's electronic medical record. How to say, like to someone, oh, I would much rather be at a facility that is cared for me in the past as I, like have something special like a transplant. Please send me back to my hospital that did the transplant. Right? And then I talk about what goes on in the emergency department. And then the four so days that you can expect to say in the hospital, the average stay in the hospital in the country at this time is around five days. And so I broke it down in, into that. And so what I would say is to somebody pick up the book and find where you are. If you're like, oh, wow, I, you know, my dad's been in the hospital for two days, pick it up and start looking around day one, day two and, and say like, okay, what's going on?

Dr. Nugent (16:50):

Are we in information gathering phase at this hospital stay? Which, which I talk about where, like in the beginning of your hospital, say they may be sending you for a lot of tests and you're meeting a lot of people, it's tiring. It can be a little confusing. And this is the time you've gotta really take notes and say, what tests did I get? How, what were the results? Who is this neurologist? Things like that. Or are we in the phase where we're planning for discharge a little bit more? And I really should be working with physical therapy and speech therapy to see like, am I able to go home with a little bit of extra equipment or do I have to make a stop in a rehab facility because it's not safe for me to go home? And so granted, anything can happen in any order. But I did my very best to try and, and make it something that you could pick up and say like, okay, now this is where we are.

Larry (17:46):

Being in the hospital itself. Being in a bed in a Johnny is, is enough of an experience. How do you advise people to get through that experience?

Dr. Nugent (18:00):

Lean on your community. People love you and they want to show up for you in whatever way that they can. Being hospitalized is isolated, the world is still going, and you're not right. You're taken out of your milieu, out of your everyday abilities to do things. Yet your daughter is still going to Costco with grandkids and your neighbor's still going to work. Like the, the world is still going. It can feel isolating. And it's scary, right? Either you're dealing with something unknown and you're getting a new diagnosis, or it's an exacerbation of something that you've had and you may be feeling despondent. Whatever you do for your mental health, I'm a big journal person. I write out my thoughts concerns and worries. Do those things and lean on your community. You know? If people wanna come visit you, if you, if you can take the visits.

Dr. Nugent (18:56):

'Cause I understand visiting can be tiring sometimes, but you know, it helps to have a friendly face come in and make you smile for a little bit or sneak you in your favorite food. You know, you get a, a little, couple tastes that maybe are, can be contraband for a second, right? It makes a difference. It really does make a difference to lean on. And if you feel like you don't have that community, please ask for the chaplain's. Office will come by, even if you're not a religious person. They can come by just for a social, social visit. You know, if you have your cell phone, your computer, and you're someone who is big on Facebook, let your let your community show up for you. You know, you'd be surprised. I've seen people have things delivered, you know, flowers that they didn't expect from a Facebook message that they sent to an old friend. And so don't go it alone is the biggest thing that I can say.

Larry (19:53):

How do you manage food in the hospital?

Dr. Nugent (19:55):

<Laugh>? Oh, food is like my favorite thing to talk about in the hospital. Because food in the hospital is not just you know, nutrition, food in the hospital is often prescription. And food in the hospital can also pose dangers, right? And so someone's food can change what they need from textures can, can change. Someone may not be able to tolerate normal food. They may choke on normal food and may need like soft food or chopped up food. And then we're talking about sodium. We're talking about fluid. Like food in the hospital to me is a really big thing. If you don't have dietary issues in the hospital, if, if you're not being given what I refer to as a prescribed diet then like sure, tell your friends who bring you your favorite subway sandwich and like, get comfortable and, you know, just don't make that another thing that's gonna be a worry for you.

Dr. Nugent (20:52):

You know, feel free to pick off whatever on the menu, but if you are prescribed a diet for a medical reason, like a renal diet, you've had the kidney issues and your kidney specialist, your nephrologist, that's to you. You really can't eat too much potassium. You really can't eat too much sodium. This is a time to ask for a nutritionist to come and sit down with you. And, and because everyone's diet is different from preferences personally to cultural preferences, and you don't want to take yourself out of the experience when you leave the hospital of like graduations and holidays and things like that. So you have to learn how to live with that diet. If you have a prescribed diet that's specific for texture, for whatever reason, you know, like after stroke or an in injury cell may not be safe to swallow things this is the time to really work with physical therapy and speech therapy to see if this is gonna be a permanent change in your diet or can you work and over time upgrade because those type of diets change, they're very fluid.

Dr. Nugent (22:01):

I see people who come in eating regular food, they have an event they leave with like soft or chopped up food, and the next time I see them, if they're hospitalized, they're back on regular food, right? Those things can change over time. And those therapists are really good at what they do to help you learn how to get that function done. You know? But the thing I say about diets is space and grace, I say space and grace about a lot of things in the hospital, but diet is a big one. Give yourself space to get used to it. Learn how you're gonna live with it, and the grace for the days that you mess up to not get down on yourself, right? Because eating is really kind of the only thing that you have to do three, four times a day other than going to the bathroom, right? But like, eating is pleasure. Eating is art, eating is culture, eating is love, right? It's sharing love with people. And so give yourself space to learn the new diet and grace for the days that you mess up and just try again.

Larry (23:11):

I asked from a personal experience when I asked the food server what was for dinner that day and she said, gray

Dr. Nugent (23:22):

<Laugh>.

Larry (23:23):

So

Dr. Nugent (23:25):

No, you know, that, that's, like I said, food in the, the hospital's one of my favorite things. Hospitals do not have good gastronomic reputations at all. A lot of hospitals are working to change that. I, I just heard that Boston Medical Center here in Boston has opened up a garden on the roof to start doing some locally grown stuff in their hospitals. I worked at a VA hospital where I would see my patients like wheel themselves down into the cafeteria and eat french fries that I specifically had said to them, we're forbidden. You know, and so it's, it's very, it's very difficult, but I think some hospitals are, are really like getting the, the, the message you, you gotta try it a little bit harder. I remember my sister-in-Law after she gave birth, she had steak and champagne somewhere in New York. <Laugh> <laugh>. I didn't get it, but she did <laugh>

Larry (24:19):

Because it's sort of the one thing you look forward to Mm-Hmm. <Affirmative> or can look forward to in a hospital admission is having a nice meal at the end of the day, <laugh>.

Dr. Nugent (24:32):

Yeah. And, and that's why I say if you don't require any special diet, like call your brother-in-Law and be like, Hey, you know, can you bring me my favorite thing? Don't, don't make that one more thing that's gonna kind of separate me from the outside world.

Larry (24:47):

One of the nice things about your book is there's a link to a checklist that makes it even easier to have something to carry around.

Dr. Nugent (25:00):

Yeah. like I said, my mission with this book is for it to be used. I, I really wanted to create something to help people. And I'm trying to get that message out to people that, you know, unfortunately, the majority of us are gonna end up in a hospital at some point in time. It's unlikely to be the most pleasant experience in your life. How can you make it a little less unpleasant? How can you be a little bit more prepared? And the quick guide is the QR code in the beginning of the book where you scan it takes to the website. And I want you to keep that on your phone. Keep it accessible to you as what I thought were the highest yield points to live on.

Larry (25:38):

And your website is,

Dr. Nugent (25:41):

It's dr monique nugent.com. So it's just my name with a DR in front of it. And I've got some really great downloads. Please, everybody goes through the website and check it out. I've got downloads to teach you how to have family meetings. These are the same skill sets that I speak with med students and residents about how could, how to communicate and plan. What is an effective family meeting, when do we need to call family meeting? I've got things for you to practice your medication list. I know I harp on it, but that is a really big safety point, is your medications. Practice writing that down. And I've got my very small blog that I'm putting more things on. You know, so keep, keep up with me and hopefully you, you find some really great information

Larry (26:27):

For those who want more information. The title of the book again is

Dr. Nugent (26:33):

Prescription for Admission.

Larry (26:36):

And it's available,

Dr. Nugent (26:38):

It's available anywhere you buy books online, amazon.com, Barnes and nobles.com. I think Apple Books is someplace someone said that they buy books online, but it is available anywhere that you buy books online.

Larry (26:50):

And to repeat, I've read through it and I think it is necessary for every, not only older patient, for every patient who's facing an admission to have anything we missed that you'd like to talk about.

Dr. Nugent (27:06):

No, this has been a really great conversation. Thank you for sharing your listeners with me. I'm really excited to get the, the message out and, and help people feel a little bit more educated before they come into our office.

Larry (27:21):

Monique, it's been great having you on. Thank you so much for the information.

Dr. Nugent (27:27):

Thank you.

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