oddshooter
Member
This started off a thread I started on trying to - keep shooting till The End. Several folks asked for a paper on my Gatekeeper concepts. Here is the first draft.
Gatekeeper
The Gatekeeper term I use is meant to describe someone that is in charge of managing, coordinating, and verifying a patient’s overall health care. They are an advocate for the patient. A close relative is usually excellent if they learn their role and are capable of carrying it out. They must be willing to work 24/7. No person I love would I leave overnight in a hospital alone. I think the error rate at night is 10 to 1 more than during the day. Number one in accidental deaths in this country is Medical error. It is number three in overall deaths behind cardiac and cancer. If you want to survive a medical encounter you should realize the problem and plan on handling it yourself.
Gatekeeper is a state of mind. It’s a focus on the patient care as well as the medical care of a patient. Advocacy is key. Two medical workers make a mob. Gatekeeper can roam the halls and get the lay of the land. Cafeteria, bath rooms, exits, nursing stations, care type others are getting, numbers on the floor…. A basic function of the Gatekeeper is to get medical assistance when needed. Never rely on a Call Button attached to the bed !!! It can be 30 minutes to never for a response.
Unfortunately, Gatekeeper is also a term used in medical insurance, particularly HMO. The first joke is that their duties are listed as managing a patient’s treatment. Nothing could be less accurate. The gatekeeper is used as a cost cutting device where they are in charge of authorizing referrals, lab orders, and even hospitalizations. They are a choke point for stopping services.
Protocol
Is a term for the standard operating procedure SOP of a medical facility. It dictates the process to be followed. Protocols are used to reduce the errors caused by personnel making up and deciding for themselves what to do. It is an easy way to cover your *** CYA legally. Few medical people have been successfully sued for following protocol. It works best in facilities with inexperienced, poor talent, and uncaring staff. It states a minimum requirement for patient care; but often it becomes the norm, not the minimum.
I find Protocol to be the worst process for delivery of individual, personal care. Protocol is often used as a club to beat a patient into submission. To me, it implies “No Thinking Allowed”.
Forcing nurses to work (3) 12’s per week is wrong. They get tired. Rotating schedules make it worse for many people as they can’t adjust to different sleep schedules. Consequently, the more experienced, better staff tend to work the day shift.
I’m a huge nurse fanboy. I believe the “laying on of hands” is an ancient medical technique that works. A dedicated nurse is a thing to behold and is deserving of all honors bestowed upon them. The healing touch turns out to be a real thing.
I’ve worked with many nurses who’ve had it. Out of a thousand doctors, I’ve met one who had it. Your gatekeeper should be practicing laying on of hands continually.
As I was leaving my last forced stay in a hospital, my surgeon and medical doctor for the last 48 intense hours, DIDN’T RECOGNIZE ME. I’m told I’m quite distinctive and we had just done the exit summary interview 2 minutes before. This doctor looks right past people and sees meat. Couldn’t be more obvious. He may be a great surgeon, but my trust meter for him was pegged at zero.
My gatekeeper reinforced that my feelings were shared by others in the room. Nurses shouldn’t roll their eyes and look up and away, but they do. Watch them for clues.
This doctor needs communication skills training. He will not get it. It’s not on his curriculum. It’s better to let the gatekeeper challenge the doctor than you.
One of the largest issues in medical care is the lack of information sharing and use. Your primary doctor may tell you one thing and then not write it into the patient chart. So no matter what the doctor finds, says, or plans; without clear communication, their staff will not carry out the doctor’s instructions.
Examples: Doctor says stop your current medication and start taking a new medication. Or he may say, I’m writing a prescription for 320mg per day because they are the same price as 160mg. You are supposed to cut the pills in half. This can be a great financial service or an unpleasant medical outcome. What gets written on the prescription label is highly variable. Pharmacies today use the prescription to be a check for the insurance companies. Let there be no doubt, the Pharmacist does not work for you or the doctor. They work for who pays them; the insurance companies.
Example 2: The doctor prescribes a blood thinner and says it’s dangerous to miss a dose or stop. You accidentally drop two into the toilet and flush. When you run out of pills at the end of the month, the pharmacist likely will tell you they can’t refill the prescription because you still have 2 pills; which you don’t. This requires the doctor to rewrite the prescription and everyone knows it takes time to get a doctor on a phone. Sometimes days to weeks.
Smart gatekeepers know this and will work the doctor to get at least an extra month’s supply. This of course infuriates the insurance company because it looks like they are paying for extra, or someone else’s , medications.
Gatekeeper must catch the conversation and monitor the dispensing. Pill caddies are required to remove patient errors.
Example 3: First doctor after carefully reviewing a case file says overnight hospital stay is not recommended. Second doctor cites “Protocol” and says you have no choice but to stay. The two doctors never speak.
Gatekeeper must catch both conversations and let the second doctor know that he may have been hasty in his countermanding of the first doctor. Several things just happened. Your gatekeeper is letting the doctor know gently that he is too quickly basing his order on inadequate information. Your gatekeeper is also letting the second doctor know that he just questioned and disrespected a fellow doctor’s medical orders.
There are a few truisms in medicine, and in life. One of those cliches is, People take care of people they like. Being aggressive, challenging, or abusive is the worst idea going.
Learn the basics of communication:
Name calling is just verboten.
Character assassinations are forbidden as well.
ALWAYS preface a possible negative comment by a positive comment.
Don’t use declarative statements. “That’s wrong”.
Use questions instead “Is that right?” or “That seems different somehow.”
Use personal disparagement “I just can’t remember so many instructions. How do you do it?” “ I might have done it like this and made a big error”.
Don’t refuse medical treatment outright. It will be used against you later.
Instead say “We would prefer not to do that at this time”
“I think it would be prudent to check with Doctor X. I have a question.”
“Does that seem like contradictory instructions from the doctors?”
I feel certain there must be other options. Can you please help me find them?
Gatekeepers are sober, as opposed to the patient on drugs. Remembering or writing down instructions is one of the basic functions.
On occasion, there will often be a gang formed like a lynch mob and surround the bed. Without a gatekeeper, you are totally outnumbered; and they can call orderlies as well. A nursing assistant will follow Protocol and take blood at 5AM even if they have to put you into cardiac arrest and watch you stroke out. Being seen as a “difficult” patient can get you restrained. If you’ve never seen “One Flew Over the Cuckoo’s Nest”, DON’T.
Gatekeepers have the role of the bad guy at times. That’s much preferable to seeing the patient as the bad guy. They are there to deflect all negative toward themselves.
Of course, my gatekeeper delivered a huge box of Reeses’s candies (white chocolate, bits, rounds, crunchy) to the Nursing Station when we arrived. We kept specialty Sea Salt Caramels in the room for when anyone who came by. As you can imagine, we were seldom alone for long. They knew my gatekeeper by first name and asked if he was married. We had the best care on the floor.
People take care of People they like.
Find a bed on the wing. Create a bed with chairs and cushions. Bring a camp lounge chair. Just don’t leave!
I’m still working on this and I would love constructive feedback.
Prescut
Some long term hospital stays make some of the guidelines impossible. Many of us can do 24/7 for a few days. Few can do a year. There's now a section about taking care of the Gatekeeper coming.
Gatekeeper
The Gatekeeper term I use is meant to describe someone that is in charge of managing, coordinating, and verifying a patient’s overall health care. They are an advocate for the patient. A close relative is usually excellent if they learn their role and are capable of carrying it out. They must be willing to work 24/7. No person I love would I leave overnight in a hospital alone. I think the error rate at night is 10 to 1 more than during the day. Number one in accidental deaths in this country is Medical error. It is number three in overall deaths behind cardiac and cancer. If you want to survive a medical encounter you should realize the problem and plan on handling it yourself.
Gatekeeper is a state of mind. It’s a focus on the patient care as well as the medical care of a patient. Advocacy is key. Two medical workers make a mob. Gatekeeper can roam the halls and get the lay of the land. Cafeteria, bath rooms, exits, nursing stations, care type others are getting, numbers on the floor…. A basic function of the Gatekeeper is to get medical assistance when needed. Never rely on a Call Button attached to the bed !!! It can be 30 minutes to never for a response.
Unfortunately, Gatekeeper is also a term used in medical insurance, particularly HMO. The first joke is that their duties are listed as managing a patient’s treatment. Nothing could be less accurate. The gatekeeper is used as a cost cutting device where they are in charge of authorizing referrals, lab orders, and even hospitalizations. They are a choke point for stopping services.
Protocol
Is a term for the standard operating procedure SOP of a medical facility. It dictates the process to be followed. Protocols are used to reduce the errors caused by personnel making up and deciding for themselves what to do. It is an easy way to cover your *** CYA legally. Few medical people have been successfully sued for following protocol. It works best in facilities with inexperienced, poor talent, and uncaring staff. It states a minimum requirement for patient care; but often it becomes the norm, not the minimum.
I find Protocol to be the worst process for delivery of individual, personal care. Protocol is often used as a club to beat a patient into submission. To me, it implies “No Thinking Allowed”.
Forcing nurses to work (3) 12’s per week is wrong. They get tired. Rotating schedules make it worse for many people as they can’t adjust to different sleep schedules. Consequently, the more experienced, better staff tend to work the day shift.
I’m a huge nurse fanboy. I believe the “laying on of hands” is an ancient medical technique that works. A dedicated nurse is a thing to behold and is deserving of all honors bestowed upon them. The healing touch turns out to be a real thing.
I’ve worked with many nurses who’ve had it. Out of a thousand doctors, I’ve met one who had it. Your gatekeeper should be practicing laying on of hands continually.
As I was leaving my last forced stay in a hospital, my surgeon and medical doctor for the last 48 intense hours, DIDN’T RECOGNIZE ME. I’m told I’m quite distinctive and we had just done the exit summary interview 2 minutes before. This doctor looks right past people and sees meat. Couldn’t be more obvious. He may be a great surgeon, but my trust meter for him was pegged at zero.
My gatekeeper reinforced that my feelings were shared by others in the room. Nurses shouldn’t roll their eyes and look up and away, but they do. Watch them for clues.
This doctor needs communication skills training. He will not get it. It’s not on his curriculum. It’s better to let the gatekeeper challenge the doctor than you.
One of the largest issues in medical care is the lack of information sharing and use. Your primary doctor may tell you one thing and then not write it into the patient chart. So no matter what the doctor finds, says, or plans; without clear communication, their staff will not carry out the doctor’s instructions.
Examples: Doctor says stop your current medication and start taking a new medication. Or he may say, I’m writing a prescription for 320mg per day because they are the same price as 160mg. You are supposed to cut the pills in half. This can be a great financial service or an unpleasant medical outcome. What gets written on the prescription label is highly variable. Pharmacies today use the prescription to be a check for the insurance companies. Let there be no doubt, the Pharmacist does not work for you or the doctor. They work for who pays them; the insurance companies.
Example 2: The doctor prescribes a blood thinner and says it’s dangerous to miss a dose or stop. You accidentally drop two into the toilet and flush. When you run out of pills at the end of the month, the pharmacist likely will tell you they can’t refill the prescription because you still have 2 pills; which you don’t. This requires the doctor to rewrite the prescription and everyone knows it takes time to get a doctor on a phone. Sometimes days to weeks.
Smart gatekeepers know this and will work the doctor to get at least an extra month’s supply. This of course infuriates the insurance company because it looks like they are paying for extra, or someone else’s , medications.
Gatekeeper must catch the conversation and monitor the dispensing. Pill caddies are required to remove patient errors.
Example 3: First doctor after carefully reviewing a case file says overnight hospital stay is not recommended. Second doctor cites “Protocol” and says you have no choice but to stay. The two doctors never speak.
Gatekeeper must catch both conversations and let the second doctor know that he may have been hasty in his countermanding of the first doctor. Several things just happened. Your gatekeeper is letting the doctor know gently that he is too quickly basing his order on inadequate information. Your gatekeeper is also letting the second doctor know that he just questioned and disrespected a fellow doctor’s medical orders.
There are a few truisms in medicine, and in life. One of those cliches is, People take care of people they like. Being aggressive, challenging, or abusive is the worst idea going.
Learn the basics of communication:
Name calling is just verboten.
Character assassinations are forbidden as well.
ALWAYS preface a possible negative comment by a positive comment.
Don’t use declarative statements. “That’s wrong”.
Use questions instead “Is that right?” or “That seems different somehow.”
Use personal disparagement “I just can’t remember so many instructions. How do you do it?” “ I might have done it like this and made a big error”.
Don’t refuse medical treatment outright. It will be used against you later.
Instead say “We would prefer not to do that at this time”
“I think it would be prudent to check with Doctor X. I have a question.”
“Does that seem like contradictory instructions from the doctors?”
I feel certain there must be other options. Can you please help me find them?
Gatekeepers are sober, as opposed to the patient on drugs. Remembering or writing down instructions is one of the basic functions.
On occasion, there will often be a gang formed like a lynch mob and surround the bed. Without a gatekeeper, you are totally outnumbered; and they can call orderlies as well. A nursing assistant will follow Protocol and take blood at 5AM even if they have to put you into cardiac arrest and watch you stroke out. Being seen as a “difficult” patient can get you restrained. If you’ve never seen “One Flew Over the Cuckoo’s Nest”, DON’T.
Gatekeepers have the role of the bad guy at times. That’s much preferable to seeing the patient as the bad guy. They are there to deflect all negative toward themselves.
Of course, my gatekeeper delivered a huge box of Reeses’s candies (white chocolate, bits, rounds, crunchy) to the Nursing Station when we arrived. We kept specialty Sea Salt Caramels in the room for when anyone who came by. As you can imagine, we were seldom alone for long. They knew my gatekeeper by first name and asked if he was married. We had the best care on the floor.
People take care of People they like.
Find a bed on the wing. Create a bed with chairs and cushions. Bring a camp lounge chair. Just don’t leave!
I’m still working on this and I would love constructive feedback.
Prescut
Some long term hospital stays make some of the guidelines impossible. Many of us can do 24/7 for a few days. Few can do a year. There's now a section about taking care of the Gatekeeper coming.
Last edited:
