Patient Advocacy

My husband Steven has a history of bladder stones. The first time one was discovered, it was the size of those small foil-wrapped chocolate Easter eggs. As far as bladder stones go, it was quite large and had to be removed surgically. Since the discovery of that first bladder stone, Steven has gotten an annual sonogram to catch any stones early, so they can be removed with a laser rather than through a cut in his abdomen.

We recently got the results of Steven's latest sonogram, and thank heavens this is the second year in a row that he was given the all clear. It reminded me, however, of the last time he required stone removal and the difficulty I had in standing up to a doctor, an anesthesiologist unfamiliar with Steven's case.

How is it that despite everything I know about being a patient advocate, and the fact that I have my title as President/Co-founder of the National Family Caregivers Association to bolster me, standing up to doctors still requires a special effort? I don't know the answer. I just know that it does and that I constantly must remind myself that "we" are the customers and therefore have a right to ask questions, receive satisfactory answers, and choose the key members of our health care team.

In our case, Steven and I were at the hospital for a fairly minor procedure called lithotripsy, which involves using a laser to zap bladder stones that Steven's body seems to generate on a regular basis. Having gone through it before, we knew the drill and didn't have any special concerns.

We have total confidence in his urologist Dr. H, and the hospital in Washington, DC, where he practices, and really like a certain anesthesiologist on the staff, Dr. L, who has been part of Steven's surgical team for several years now. The first time we met Dr. L, he explained the various anesthesiology options open to Steven, and he listened attentively to our concerns regarding use of a general anesthesia in persons with multiple sclerosis, which Steven has.

Dr. L recommended a spinal approach and said he thought that given Steven's disability it was the best choice because it would leave his body fairly quickly and therefore have the least impact on his overall functioning in the immediate post-operative phase. Since it worked so well the first time for Steven, Dr. L has used the same approach and combination of drugs each time Steven has undergone this procedure.

That's why we were surprised when a new anesthesiologist, Dr. F, came into Steven's room and started talking about using a general anesthetic. "It will get you out of the hospital sooner than anything else," he said. "In my experience that's what patients want, to go home quickly." I must have had an incredulous look on my face because he got all huffy and told me he had been practicing for 16 years. "It's just that Dr. L always used a spinal in the past because he thought it would be best given Steven's condition and there never has been a problem," I said. "Well, with the spinal drug Lidocaine you won't be able to leave the hospital for many hours, and it can cause back spasms," Dr. F added. "I don't use it for those reasons."