#311: Dr. Julie Siemers - How to Survive Your Hospital Stay
Learn more about the patient advocacy work of Dr. Julie Siemers
At PLANTSTRONG, we're all about empowering people to take charge of their health through food, movement, and education. But what happens when you're in the hospital and no longer in control?
This week on the podcast, we’re joined by Dr. Julie Siemers, a patient safety consultant and critical care nurse who has spent over 45 years on the frontlines of healthcare. She brings a message that everyone needs to hear: preventable harm in hospitals is far more common than most people realize.
Despite decades of focus, medical errors and breakdowns in communication continue to be a leading cause of death in the U.S. And the worst part? Many of these tragedies are avoidable.
What can you do? A lot, actually.
Dr. Siemers shares the signs to watch for when a loved one is hospitalized, how to speak up when something seems off, and why being an active participant in your care could save a life.
Key Takeaways:
Patient Harm is Common—But Often Avoidable. Many hospital injuries and deaths stem from poor communication and missed warning signs. Subtle symptoms like confusion, shallow breathing, or skin color changes can be signs of rapid deterioration.
You Are the Most Important Advocate. Don’t be afraid to ask questions, speak up, or request clarification from healthcare providers. Clear communication with your care team is not just helpful—it’s lifesaving. Learn Julie’s 3Ps: Be Present, Polite and Persistent.
Don’t Go It Alone. Have someone with you during hospital visits to ask questions, take notes, and help advocate for your care.
Be Prepared Before a Crisis. Know your medications, your health history, and your plan in case of emergency.
Surviving Your Hospital Stay is available now.
Episode Resources
Watch the Episode on YouTube
Follow Dr. Siemers on Instagram
Order Surviving Your Hospital Stay
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Full Episode Transcription via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
Introduction to Patient Safety
[0:04] Could one conversation save a life? If so, this one might just be it. Today, I have an episode with Dr. Julie Siemers a critical care nurse and patient safety expert with over 45 years of experience to shed light on one of the leading yet often overlooked causes of death in the United States. Preventable harm in the hospital. We'll have her tips for surviving your hospital stay after this message from PLANTSTRONG.
The Importance of Meal Planning
[0:43] Before we dive into today's episode, I want to share something that could make a world of a difference, especially during recovery for yourself or a loved one, because coming home from the hospital can be overwhelming, especially when it comes to food. This is exactly why we created the PLANTSTRONG Meal Plan Bundle. It's a pantry-ready, done-for-you gift that helps you or a loved one eat well and heal strong. It's more than just food. It is peace of mind. This bundle includes a full seven-day meal plan with breakfast, lunches, dinners, and snacks, all made from clean, nourishing ingredients that support recovery and long-term health. There's no cooking stress, no last minute grocery runs, just simple, satisfying meals made from whole ingredients designed to help people feel better, faster. Whether you're sending love to someone recovering from surgery, an illness, or a hospital stay, this is one of the most practical and heartfelt gifts that you can give. Visit plantstrong.com and search meal plan bundle to learn more because healing doesn't end at discharge. It starts right at home.
Understanding Preventable Harm
[2:08] It's almost impossible to believe that one of the safest places to be when we're sick can also be one of the deadliest. That's right, a hospital stay. Despite massive amounts of training and all kinds of new technologies, preventable harm in healthcare is one of the leading causes of death here in the United States. Thankfully, my guest today, Dr. Julie Siemers, is on a mission to make healthcare safer for everyone. As the author of Surviving Your Hospital Stay, A Nurse Educator's Guide to Staying Safe and Living to Tell About It, Dr. Siemers shares how you can advocate for yourself and your loved ones and avoid this unfortunate fate. Dr. Siemers shares the truth about the warning signs of patient deterioration, why miscommunication in hospitals can be deadly, and what you can do to advocate for your safety. It's a conversation that just may save the life of you or a loved one. So please welcome to the PLANTSTRONG Podcast, Dr. Julie Siemers.
[3:22] Dr. Julie Seamers, I want to welcome you to the PLANTSTRONG Podcast. It is a pleasure to have you. And I know that our audience is going to get so much out of our conversation today. Where am I talking to you from today? I'm in Fairfax, Virginia, and thank you for having me on your show, right outside of D.C., so it's a nice spring day here. All right. Wonderful, wonderful. Well, I'm going to dive right in. You are a patient safety consultant. You like to refer to yourself as the patient safety expert to help make healthcare safer for all. You are a critical care nurse and educator for 45 years, and you have got an absolute wealth of information. Tell me, when did you decide, you know what, Julie, I think you'd make a good nurse? Gosh, my mom suggested it when I was 15 years old and trying to figure out what to do after high school. And she had always wanted to be a nurse. And I thought, you know, that sounds like a really good idea. And I went right in when I graduated. Right. And so no regrets. You've loved it. I truly have. And probably, you know, I've had some really exciting experiences. Places that I've worked, you know, in the trauma unit, I spent 10 years as a flight nurse on the helicopter.
[4:51] And then I got into nursing education about 15 years ago. And I just, I really enjoyed it. And that's what I love about nursing is there's so many aspects, the cath lab, the, you know, mother baby unit. So you can never be bored. And it really, truly is lifelong learning. And is that where like 15 years ago, is that when you wrote your thesis on failure to rescue? Is that correct? It sure is. Yes. You've done your homework. And so that really, if I remember correctly, you were like, well, what is failure to rescue? And it was kind of even a new concept for you. Yes. And which really shocked me because I'd already been a nurse 30 years. I'm like, why don't I know about this? Why isn't it taught in healthcare curriculum, not just nursing? And so, yeah, I kind of took it upon myself to start educating everybody I worked with at the university at the time and students.
[5:47] Yeah. And failure to rescue is, I think, as you so eloquently put it, it's basically patient deterioration. And, you know, what can healthcare workers do to, you know, kind of notice what's going on? What have you found is the number one patient deterioration that occurs?
Recognizing Patient Deterioration
[6:12] Respiratory rate changes are number one it's the most sensitive and earliest indicator of beginning patient deterioration and then neurological changes so those are two big factors that nobody really kind of hones in on and pays attention to how critical they are because it's just not been taught in this basket of awareness and all the indicators for failure rescue or beginning deterioration are all physiological, every single one of them.
[6:44] I want to dive into some examples. And you've done a really great job on Instagram and your TikTok channels of doing that. So I'm going to throw some examples that you've talked about, because I think that it's really valuable for the listener. Before we do that, though, I'd like to kind of take a step back and take a 10,000 foot view. And you talk about how there's a serious patient crisis that's facing healthcare today. And you talk about three. And let's like really, really briefly in a very overarching way, talk about those three. And I'll tee it up for you. The first one is preventable harm.
[7:28] Yeah, you know, it's not new, unfortunately. It's been in the literature for years. 25 years ago, there was a research article that came out to Air is Human by the Institute of Medicine and said we need to get to zero harm, which everybody agreed. And here, 25 years later, we're still not near zero harm. We still have preventable harm happening every single day. The rough estimates are it's the third leading cause of death right behind heart disease and cancer, impacting a minimum of 250,000 patients every single year. And if you do the math, that's 684 patients every day dying. And that's not just the harm. That's actual harm bad enough to kill a patient.
[8:20] So it's pretty intense. I mean, I've always asked myself, why? Why haven't we moved the needle? Why can't we make a difference? And I compare it to the aviation industry. You know, we have the National Transportation Safety Board that investigates every single accident. And if you compare how many people have died on commercial airline flights over the last two decades, it's only 239. And I don't mean to minimize those patients and their families, but 239 people over 20 years versus 684 every single day. That's what I call a crisis. No, that's quite a contrast. I mean, that is nutty. And those 250,000 deaths that occur each day, you talk about how on the death certificate, it's usually a...
[9:17] Uh, a physiological reason like heart attack or something like that. And so how many of those are also included in that 250,000? That is the really difficult part because for example, the nurse that gave a ring wrong medication that was all over the news a couple of years ago, pardon me at Vanderbilt hospital, they put on the death certificate natural causes. Well, it wasn't natural causes. She died. The patient did because she got a paralytic and wasn't monitored for 30 minutes rather than a sedative. And so we believe those kinds of incidents happen way more frequently because hospitals don't want to admit they made a mistake. But the problem is if we don't have transparency, we'll never fix it. We won't do the root cause analysis to try to find the system's errors that allow a human to make those kinds of mistakes. Yeah.
[10:15] All right. We're going to dive back into that and what our audience members can do to actually make sure that they survive, right? Survive their hospital stay. In fact, that's the title of the book that you wrote, Survive Your Hospital Stay, A Nurse Educator's Guide to Staying Safe
Financial Implications of Patient Harm
[10:37] and Living, right? To tell about it. That's a good thing. You also mentioned how there's all kinds of financial implications with this, you know, healthcare crisis today. What are some of those financial implications?
[10:53] It's estimated that an individual hospital spends between 13 and 15 percent of their annual operating income on patient harm. So that will include lawsuits for significant harm that they settle with family. That includes increasing the length of stay, meaning grandpa should have gone home after his hip surgery, but now he's got pneumonia and now he's in the ICU. So that cost extra. And it's billions of dollars across the U.S. that we spend on an annual basis for patient harm. That's incredible. Yeah, I think the stat that I saw you threw out was 12% of hospital budgets are spent on patient harm? 12%. I mean, that's. Yeah. So if you take a hospital in Austin that I just looked up, I've got a database where I can see all the financials and, you know, all those kinds of things of hospitals and their operating income for 2023 average size hospital was $88 million. So if we take even 10% to go a little bit more conservative, that's almost $9 million that hospital spent on patient harm that year.
[12:05] Let alone the catastrophic, you know, events that happens in people's lives when these things happen. Now, when you say that's how much they spent on patient harm, is that in the way of litigation or is that in the way of somehow having to fix the screw up that they made potentially? Both. Yeah, both lawsuits. And then really, if a patient ends up falling and that's not what they went to the hospital for and injuring or even fracturing a hip, then that is harm that could have been prevented or avoided. So all of that goes into that one pool. But again, there's a lot of opportunities. Healthcare acquired infections are another, you know, again, hundreds of thousands of patients are impacted every year. Not all of them die. Some of them just have, not just, but have extended lengths of stay and now they're on IV antibiotics or they end up getting septic from the infection, which then leads to, can lead to death.
[13:12] Yeah. And I want to, that's one of my questions. I want to talk to you about that septic because you have some pretty good stats on that. And then the third thing kind of that's facing healthcare today that you refer to as a crisis is heightened risk of costly litigation, that there are millions of dollars spent on lawsuits every year. And I can't imagine that doesn't affect all of us downstream. Right. Sure does. Yeah.
Patient Safety Concerns in Healthcare
[13:42] Okay. Well, those are the, those are the big three things. So let's, let's dive in. So.
[13:52] What have you found to be the number one patient safety concern in 2025? You know, it's interesting. There is an organization, ECRI, E-C-R-I, that every year puts out the top 10 patient safety concerns. 2024, it was that healthcare providers are graduating from school. So not just nurses, resident doctors, pharmacists, physical therapists that are not ready for practice.
[14:23] Which is really concerning because not every place of employment, acute care or otherwise, has an education department to bridge that gap. So we have a lot of practitioners who are trying to figure it out as they go, which patients are going to end up suffering from that. And in 2025, it was actually healthcare providers not listening to patients and not communicating. I can't remember the term exactly that they used in this report, but it really is on the tip of medical gaslighting, which occurs. Yeah, I think what it was is providers being dismissive to their patients, families and to their caregivers. And I think the stat you shared with us is that 94% of patients' families felt this way. And I know the last time I went to the physician, I kind of felt that way, right? I just kind of felt like they were a little dismissive, a little bit of arrogance
Advocating for Yourself in Healthcare
[15:27] that I felt that was there, not listening well to the patient. So what are some things that we as patients that should be advocates for ourselves, what do you recommend that we do with that nurse-doctor-healthcare relationship?
[15:48] It's one of the things that I tried to focus on in my TEDx talk that I gave in January, or it came out in January, and that is we have to bridge the gap between the patient and their family and the healthcare provider team, because 70% of patient harm events occur because of communication breakdown. So when we take the responsibility ourselves to understand our disease or our health, our laboratory data or diagnostics that we've had, radiology exams.
[16:22] Whatever they are, as well as our medications or health supplements that we take, really knowing what you're doing, this is your body and nobody's going to care about it more than you. But we have to take an active role and stop being passive in the healthcare system. You know, we come from a culture, live in a culture where there's this hierarchy. You know, my mom always said the doctor knows best, but that may not necessarily be true anymore. And I'm not saying healthcare providers ever intend to harm, but healthcare is so fast paced nowadays. They can't keep up with the literature or the latest technology where medical knowledge is doubling every, gosh, it was three years, but I think it's even faster now. And it's really, it's paramount that we take that active role. So, a couple of things I talk about in my book is choosing your provider. So, I would not go to or continue going to a doctor that was dismissive or didn't have time to listen to me. Number one, you know, choose your provider that you have a good rapport and that you feel respected.
[17:31] And the second one I recommend is the hospitalsafetygrade.org website, where you can go find the hospitals in your area if they're rated A through F. So your chances of harm or dying at a D or F rated hospital is about 91% higher than if you went to an A-rated hospital. So, there's five main categories that you can find once you identify your hospital, and then 22 subcategories where you can see, are they red, yellow, green, in postoperative blood clots, postoperative pneumonia, sepsis, hand-washing techniques, you know, all those indicators that will tell you whether they're a safe hospital or not. Hmm.
[18:24] Wow. Okay. So, so you mean to tell me in 2025, some physicians, physicians, nurses, healthcare workers, they're not even doing like the basic, which is washing your hands properly. Right.
The Role of Hand Hygiene
[18:40] Yeah, we decreased health care acquired infections, probably near the time of COVID, of course, because everybody was gloving up and gowning up and whatever. But I was at my dermatologist's office last spring getting a, you know, biopsy because I've had melanoma in the past. And they're like, oh, that's suspicious. He walks in the room and starts coming at me to do an invasive procedure. And I'm like, sir, can you please go wash your hands?
[19:09] It's like they just get into this task mode and don't think about it and yeah there's hospitals that have to have initiatives for hand washing and make each other responsible hey did you wash your hands you know peer to peer but i say as a patient or family member it doesn't matter if they wash their hands leaving the last room they're entering your room because that's what sometimes they'll say, well, I just did. And I need to see you do it, please. Yeah. Well, I would imagine that that is a conversation that has to be done very, strategically, almost delicately, so that you don't start off on the wrong foot with your physician. Do you have any suggestions on how to frame that request? You know, a lot of conversation can get started by curiosity. You know, I'm just curious why you wouldn't wash your hands coming to my room.
[20:13] No, but I always say be polite, too, because you're stressed out if you're the patient or the patient's family, because most of the time you don't plan on being there. You know, it's an accident or a disease that brought you there and nobody wants to be in a hospital. It's probably worse than the dentist's office. But, you know, the healthcare practitioners are stressed, too. You know, they've got many patients to see critical things going on. But being polite, even in a high-stress situation, and when you even feel vulnerable as a patient is really important. Yeah, yeah. Great, great points.
Understanding Sepsis and Its Risks
[20:49] All right, let's get back to sepsis. uh, sepsis. Um, you have a post, I think it's a TikTok post where you mentioned that sepsis soared 50% after Texas banned abortions. I don't understand the connection. What is, what's the connection there? Well, when a woman is miscarrying and the doctors in Texas, most especially were fearful that they would go to jail if they performed a DMC. And so, So, yeah, I did not do well explaining that post when I posted it, but there were some questions afterwards, and that's what I realized I missed. And so, they tried to—these were retained fetal fragments because they wouldn't do the DNC to clear them out, which caused that sepsis increase. So, yeah, it was—.
[21:40] A really perilous situation. Doctors didn't want to go to jail and, you know, patients don't want to die. So we needed to find like a middle ground of really clarifying that law there, especially in Texas. Yeah, yeah, got it.
Timing of Surgical Procedures
[21:56] You tell people, it's probably not a really good idea to have surgery on a Friday. Why is Friday not a great day to have surgery?
[22:10] The statistics are quite alarming about the poor outcomes with surgery on Fridays. A lot of times, if it's a teaching hospital, there'll be residents there. Now, residents are doctors, but they're learning. And they're supposed to call the senior physician or the attending physician when they have questions or, you know, they're unsure what to do. But what they found is that just doesn't happen very often. The resident will think they know how to handle the situation, and sometimes that can deteriorate very quickly or deteriorate if interventions aren't done in a timely manner. There's less staff at the hospital. There's less people in the hospital to even do emergency radiological exams, et cetera. So it's like not quite half staff, but definitely the quality deteriorates over the weekend. Right. So if you want the A-team, Monday through Thursday, same thing with Saturday, Sunday?
[23:15] Yes. Right. Okay. Okay. If it's an emergency surgery, don't delay. If you have to have an appendectomy because your appendix rupture, don't delay.
Medical Errors and Their Consequences
[23:27] But elective surgery, yes. Wait. Yeah. So let's talk for a sec about kind of, I'm going to call this medical screw-ups. And you talk about one that happened to you where you went in for a colonoscopy and you looked up on the screen and it was somebody else's name, not your own, right? Right. I was talking to a buddy of mine this morning who's going in for hip replacement surgery in a week and a half, and he was finishing up all the paperwork, and he told me that they have him in for a right knee replacement surgery. So he's going to write to them about that. You actually have a post where you talk about there was, I can't remember what hospital it was, but a man went in to have a spleen removed and they inadvertently removed his liver. This sounds like...
[24:25] Stuff that's just, it almost sounds like, you know, too far out there.
[24:31] Yeah. Yeah. Exactly. Around the campfire. But this stuff really happens. Oh, my gosh. It's horrifying. But yes, it does. In fact, when that story came out in the news and it was a hospital in Florida, I was on a bus with physicians in Southern California going to a patient safety conference at UC Irvine. And I'm reading my news feed and I'm like, can you guys believe this? And they're like, no, that's fake news. And then we researched it and they're like, oh, my goodness, this really happened. Yeah. So it's like that surgeon already, now that they're doing some digging, had done three different surgeries on the wrong body part or that had really bad outcomes. Two of the patients died. A third one didn't, like took out the pancreas instead of, I mean, it was just I can't remember the details. But, you know, that's one of my biggest concerns as a health care consumer. We don't have anywhere where we can actually go see, is this doctor a one star, two or three or four or five? The medical board, the AMA, American Medical Association, really protects their own. And even a lot of hospitals are like, we don't have enough doctors. We can't piss them off. You know, excuse my French, but, you know, we need to retain them. And so they're very reluctant to call them out on poor performance, which to me is really scary.
[25:59] Well, and I think with that same example, where the doctor removed the liver instead of the spleen, they tried to hide it, right? They did. I mean, and I think you talk about or somebody talked about how the CEO was there talking, I think, to the physician about it, and they tried to blame it on a, what was it?
[26:24] An aneurysm in the splenic artery, which just blew, you know, and the patient, they couldn't rescue the patient because he bled out. Well, when the private autopsy was done by the patient's wife, who's a nurse, she's like, there is something really wrong with this whole picture. And that's when the private medical examiner told her there is no liver there, but the spleen is still there. Said that it all was a lie. Cover up. Yeah.
[26:58] Ah, just so egregious, it's incredibly upsetting.
The Opioid Crisis and Narcan
[27:05] All right, let's turn to all the drug use right now that's going on. You did a TikTok video on a 14-year-old that died of accidental fentanyl overdose. And you talk about the three most popular drugs that are being used right now. And then you also talk about Narcan. I'd love to just kind of whet the audience's appetite a little bit on what's going on with some of these recreational drugs and Narcan and stuff. Yeah.
[27:40] I find anything health-related, especially because I've got kids and grandkids, that just what people need to be aware of. And knowing that these teenagers are finding still the three top ones, like you said, are Percocet, Adderall, and... Oxycodone yeah those are the three recreational drugs that they feel are pretty safe that'll get them high etc um the adderall i guess is just to keep awake but and i honestly don't know why these illegal drug you know distributors are lacing or filling medications with um you know the fake medications or the counterfeit with fentanyl other than it's highly addictive i I believe it's about 100 times more potent than morphine, which is why even a small dose will stop a person from breathing.
[28:39] And these kids are just thinking they're going to play around and take an oxycodone, but they're buying them off Snapchat and Instagram or from friends who get them in the same places. And so the Narcan or the Naloxone is a medication that reverses the opioid effect. And really what the opioid overdose does is people quit breathing. And so they just die because they haven't taken a breath. And so I thought it was really interesting that some of the bars and nightclubs in the Twin Cities have trained their bartenders on how to use the nasal inhaled, you can squirt it up the patient's nose, of the Narcan to reverse, if someone's unconscious, unresponsive, and not breathing, you know, reverse the overdose. Yeah. Well, I can tell you, Julie, as a former firefighter, I probably encountered 50 different people who had overdosed.
[29:38] Gave them the shot of the Narcan, and it's amazing how quickly they come back to life. Swinging, right? They're typically very upset, right? Yeah. Because you just ruined their incredible high. You also mentioned, which I found was really interesting, that they're now putting vending machines with Narcan, I think you said in front of like fire stations, if I'm not mistaken. In the Twin Cities. In the Twin Cities. Yeah. And you can buy it over the counter, but honestly, unless you think someone that you love and are around frequently, why would you need one, you know, a dose of Narcan?
[30:17] But thankfully, the other boy that I talked about, someone at that party, an adult did have some Narcan and that's why he survived. So, yeah. Now he's going to AA meetings, you know, at 15 years old, 6 a.m. Before high school every day. Just crazy. Yeah.
The Impact of Health Agency Cuts
[30:36] So let's talk for a sec about, as we all are very, very aware, the Trump administration is axing federal health agencies, you know, like there's no tomorrow. And obviously, there's got to be some sort of implications that come along with that. And I'd love to hear from your perspective, what are two or three agencies that have been cut? And what do you think are some potential repercussions? I am really frightened, honestly. The research that is being stopped, the communication between us and the WHO, what's going on in other countries, we're not sharing data and research anymore, they're just stopping it. You know...
[31:23] There's also patient safety. There's a website that I can't remember off the top of my head that I go to a lot that is rife with articles and research and evidence-based and peer-reviewed that a lot of medical providers have leaned on. And I'm afraid if they shut that website down, number one, they're stopping research, it seems, in critical areas. But if we don't have those resources to go to and say, hey, I've got a perplexing patient here, or what is the latest treatment for X that we're going to fall back into the dark ages of kind of the wild,
The Risks of Staffing Shortages
[32:05] wild west, really? Yeah. You mentioned, for example, the CDC and also with STDs, especially transmitted diseases. Can you speak to that for a sec?
[32:18] Yeah, so the one department in the CDC that was actually tracking different strains of gonorrhea, I think there was 50,000 of them at this lab that got shut down. And what they were doing is trying to make sure that they were identifying these different strains so they could track for antibiotic resistance. Yeah. And if that stops and shuts down, that that means, and gonorrhea is still a real problem. When we think about it, you know, back in the 50s or 60s or whatever, you know, and get the old penicillin shot was kind of a joke, I guess. But, you know, it's been eradicated for a long time or the numbers have been quite low. But if antibiotic resistance isn't, if we don't develop new drugs to address the new strains and microbes are smart, they want to live and survive. So they evolve. And if we don't keep up, I mean, we're already at risk of so many newer microorganisms that are drug resistant. There's a category called multi drug resistant antibiotic or microbes. And so, you know, what we used to use that would treat like a pneumonia may be resistant now to antibiotics we've used for a long time, and we have to have new ones developed.
[33:45] And it's just scary to me that we would think of shutting down medical research or slowing it down and closing those departments that really benefit the health of our country. Yeah.
[33:58] So in a similar vein, you also talk about how there's the potential for 350,000 health workers that could potentially face deportation. And like explain to me how this which which. Yeah.
[34:23] Which part of health care is going to be affected by that, you think, the most? Well, long-term care facilities, for sure.
[34:32] It is hard work. They are understaffed as it is. And if they're going to lose their CNAs or patient care technicians, help caring for the older patients that are sometimes our grandmas and grandpas, I honestly don't know what's going to happen. I think I did a post maybe last fall that talked about 700 nursing homes were looking to close because they couldn't keep their doors open. They couldn't keep it staffed, and then they couldn't pay. Reimbursements were being decreased. So with these newer changes, which are deeper cuts and losing those personnel that aren't trained, I mean, they're trained, but not to the level of medical for a nurse or a doctor, they're not going to be able to survive. But also the acute care centers you know people that work in the kitchen people that work work in the laundry department um people that you know clean the floors or use the right cleaning to kill all the bacteria in between you know patient left this room and now we're getting a new patient in it's got to be sanitized so that it kills all those microbes i just honestly i don't know what's going to happen it's really really scary yeah uh let let's.
Effective Communication with Healthcare Providers
[35:54] Let's shift and talking more about how people can advocate for themselves in the hospital. And the example that I want to use, you talk about it on TikTok, where there's a wife, and she is vehemently challenging the doctor. She's like, he's not right. And she wants to do a battery of tests, including a CAT scan. And he is just very flippant and dismissive and like, no, I don't think he needs it.
[36:29] Do you remember that specific example? I'd love for you to share it then. And the lesson learned there by this wife being so insistent and how we need to fight for our health care in hospitals. Yeah, I think I'll start with saying that all of us are going to be a patient or have a family member that's going to be a patient someday. I mean, there's just the health of our nation. And I know your culture here and your podcast and your followers are very, very active, proactive in keeping healthy. And that's the amen best thing that we can do. But in the cases that we are, you need to be informed and educated now, because when you or your family member becomes a patient, you're vulnerable, you're scared, you're not thinking right. So really get informed and educated now. That's what I would say. The other thing I'll... Can I just stop for a second and say, so...
[37:34] And so these doctors and these nurses, I mean, they've been doing this for, you know, 20, 30, 40 years. When you say get informed, so let's say I'm going in for, I don't know, a bypass surgery, open heart bypass surgery. You like, like really read up on everything you can regarding that. Is that what you mean? What do you mean by get informed?
[37:56] Well, I wrote the book to help patients and their families. And I tried to write a chapter that would talk about vital signs, talk about high-risk medications, talk about tubes and drains and or the patient's family member that's in the hospital. I'm like, oh, you know, grandpa's got an NG tube and now he's got a Foley catheter and now he's got a central line and he's got, you know, multiple drips going on. I see his monitor with his vital signs. And the intention wasn't to make a nurse or a doctor or healthcare provider out of people, but it was just like, oh, now I know what you're talking about. And now I know what that means rather than just being the passive recipient of healthcare. You can ask really informed questions like, what medication are you giving my mother? Well, it's for her blood pressure. Well, look at her blood pressure now. I don't see that as a problem. Oh yeah, you're right. I mean, they get into task mode and just start doing things or, and that's what I mean about being informed. You're Like what medications is my mom taking? What are you giving her? For example, there was a case in California.
[39:04] Where a patient got the blood thinner medication, the nurse forgot to chart it in her haste. The nurse coming behind her gave it because she saw it was not documented. And this patient ended up dying from a cerebral bleed because of the double dose of blood thinners and had just for instance, say you were there, that was your sister. And you're like, wait a minute, she already had her blood thinning medication. Why are you giving it to her again? Oh, let me go check. This is where family's voice can really come in. Is participation, just understanding you must ask these questions because as I said earlier, 70% of patient harm is communication breakdown. And so we need to be that bridge between the healthcare provider and family member in that bed. So the case you were talking about, she was a nurse, luckily. And yes, she brought up many things that were dismissed. And eventually, she got what she wanted and saved her husband's life, but he still had a whole year of recovery because everything was delayed. But here's the tip I want to give to your audience, the three Ps. Be present.
[40:17] I'm writing this down. Hold on. Let me write. Okay. Present. Yes. And I mean that from be present in your heart to not just physically present, but really come from a place where you want to be an addition to the health care team, not a pain in their butt.
Strategies for Patient Advocacy
[40:32] Right. So be present, be polite, which we talked about already. And the third one is be persistent. And that means there is a chain of command in the hospital. So you've got your nurse, there's a charge nurse, there's a house supervisor, there's a medical chief of staff, and there's a hospital administrator on call 24-7.
[40:56] So that's what she had to do is escalate past the doctor to get what she needed and wanted. And, you know, don't be alarmed or don't be frightened because you don't know something. You as a family member know that patient better than anybody and stick to it when you say, my mom's not acting right. And there, I guess it'll run into what I can share with your audience about the cuss words. Yes. Okay. So concerned, uncomfortable, scared, and a safety situation. Anytime you use those words with the healthcare team, it should grab their attention to say, I need to pay attention and investigate a little further. So I'm really uncomfortable. My husband never acts like this. Something is going on and you need to help, you need to figure it out. Or we need to figure it out together, but this is not like him. Or I'm really concerned. There hasn't been any urine output for the last 10 hours, and I know that's not normal. That means to me there's not enough blood flow going through the kidneys, so what's going on here? Let's investigate together. You know what's really interesting in hearing you describe all this, and I know there's only one of you, Julie.
[42:18] If I was going into the hospital or one of my parents was going to the hospital, I would almost want to hire you to go in with me to make sure that there's, you know, everything is above board and we're getting the best possible treatment possible. I mean, I would imagine there are people like you that do that. Right. Especially considering what are the stats? Is it is it one in four people get harmed in a hospital stay? Is that right? They do. Yeah. One in four Medicare patients. And then if you look at all ages, it's one in 10. Yeah.
The Role of Private Equity in Healthcare
[42:57] That's startling. I mean, not good odds. No, no. And so, yes, you need to be on your toes and you need to be watching. And I hate to say it, but we do have to take that responsibility. Another tip I'll give the audience is take a notebook and write down everything because you're never going to remember it. And what you can say is, oh, wait a minute. Let me look back. Yesterday, the other doctor said this, that seems conflicting. Can we discuss this? I don't understand.
[43:28] I recently turned 62 and I look around me and I'm amazed how many of my friends are getting knee replacements, hip replacements. And you have a post about metal from joint implants that's leaking into brain fluid and specifically like the cobalt is toxic to brain tissue. What can we do? I mean, for those that are listening, because it's primarily an older audience that is potentially going to get a knee replacement or a hip replacement, is there a particular metal to stay away from? So cobalt, titanium, and aluminum are the top three offenders that leach out into the blood. And like you said, now they have found it in the CSF, the fluid around the brain and the spinal cord, which is neurotoxic, which is why patients are getting psychotic and they're getting early dementia, you know, from these elements. And so I would certainly ask if you need to have a joint replacement, what are the materials in the prosthetic that you want to use?
[44:41] Yeah. And so in your opinion, what is the safest material? You know, I haven't researched that. Okay. Yeah, I haven't, but I certainly would. Yeah. I think it might be some sort of a vegetable.
[44:59] That would be good fail stock when it breaks down it just kind of gets absorbed by the body we need to ask ai yeah yeah yeah we we will do that for sure um you, mentioned that 30 percent of blood clots are fatal that seems alarming especially considering you also say it's preventable. Help me with that. Post-operative are the most common. I mean, blood clots can occur with someone who's got a clotting disease that they didn't know or blood clot issues. Women taking hormone birth control, lack of mobility. So sometimes people that have been on an international flight for 10 hours and didn't move around at all can be you know, prone to blood clots, but postoperatively, again, it's the immobility.
[45:52] When you, let's just say you had spine surgery or hip surgery, you've got pain and you don't really want to really get up and move, but there are things to prevent it. There's something called sequential compression device, which is a plastic sleeve that goes over your leg. It's connected to a little pump and it squeezes and releases. And it's, the idea is to get that blood flow from the legs, which is where most blood clots start, is in the calf. You know, that area there just pools. And so if we could get that blood flowing back up to the heart, then it can't clot.
[46:24] And then early mobility. And then the other one they will usually give is an anticoagulant in the belly, a little tiny needle in the belly anticoagulant that will help. But this is an area, again, where you can become informed if you're going to have surgery. Look up your hospital on that hospital safety grade and see how they do in the surgical department. And then ask your surgeon. I see that this hospital doesn't have great safety statistics for postoperative respiratory failure, you know, or acute kidney injury or blood clots. So help me understand postoperatively how you're going to remain safe as a patient. I'm actually surprised that the hospitals self-report on all that stuff, especially if they're doing poorly.
[47:16] Oh, well, there's another thing we have to report that's going to bring our grade down. Well, yes, it's called part of the value-based purchasing that Medicare instituted several, quite a few years ago, that really rewards hospitals for good behavior or safe behavior or penalizes them, which we're seeing now in 26, 27, and 2028, more penalties coming if we don't have good outcomes. So readmissions and certain things are going to be penalized 1%, 2%, 3% by CMS, which is significant money that they're talking about.
[47:55] Earlier, you mentioned communication breakdown and how like 70% of the time there's some serious communication breakdown. You have a post where one of your biggest concerns is patient discharge. That's where I think communication breakdown is at its all-time level. Maximum. Why is that the discharge? Medications. Yeah. Yeah. It's called medication reconciliation. So if a patient comes in and they're taking, let's just say these five medications, and then in the hospital, they're on different medications or additive medications, and then going home, the reconciliation is supposed to be, they're not overlapping. Like you're not going to take two blood pressure pills now, or you're not going to have two blood thinners, which actually happened with one of the patients, my students and I were taking care of in the hospital. She was taking a blood thinner for atrial fibrillation, which you know what that is. And then they also continued her, the blood thinner because she had knee surgery. So she was double dosed in blood thinners and bled into that compartment, the knee, where she had surgery, causing compartment syndrome, which means it's cutting off all the blood flow and came in with a cold blue foot. And luckily early enough that they could restore circulation.
[49:20] But identifying those medications that could cause a problem, so that's one piece of it. Understanding what to watch for, signs of infection, where there's real problems that you must come in and look or get checked out. I know that knee and hip surgery patients are going home sometimes the same night of surgery. So here is a big caution. I would say, usually they're going to be on some opioids for a couple of days, which causes respiratory depression. So that just means their breathing rate is going to slow down with the opioids. And in the hospital, they're monitoring that. But at home, you may have to, you know, put a pulse oximeter on and go in when it gets low enough, you know, to know that there's a problem with breathing. You know, the other thing with discharge instructions is make sure you ask, what is the recent set of vital signs?
[50:20] Because, you know, again, normal vital sign ranges are easy to look up and find. But I think one of the TikToks I posted was the lady that went home with a heart rate of 127. And she fell in her driveway and ended up with a compression fracture in her spine and had to go back to the hospital. She should have never been discharged with a heart rate of 127. Yeah, that's really elevated. What is, in your opinion, what are the correct respirations that somebody should have per minute? If they're sleeping, you know, 12, 14. If they're just awake and breathing normally, anything 20 or under, between 12 and 20.
[51:06] As we talked about earlier, respiratory rate being the single most sensitive indicator to patient deterioration, what we're talking about in that usually is the higher end because when, if we go back to pathophysiology and cellular biology, when the cell need more oxygen, which happens in fevers and infections and sepsis, you're going to breathe faster. And so missing that cue is really important, but also the hypoventilation with opioids or sedatives is really important to watch also. Such good information. I hope everybody's taking copious notes. This is my last kind of question for you. And that is, you also have a post where you talk about private equity getting involved now. And I think, correct me if I'm wrong here, but are they actually buying up hospitals, private equity groups? Yes. And how, in your opinion, this is a bit of a mistake, especially when it comes to improving health care. Yeah. They are profit-driven, which they're a business. I get that. I mean, hospitals are, you know, profit-based, too. most of them. And then if you think about when they cut supplies, they cut staff.
[52:32] The repercussions of that, our patient safety is even worse than it is now. I mean, there have been documented deaths because of not enough staffing with nurses. I think one hospital had to close because they couldn't pay their supply people, you know, for dressings and IV pumps and medications. Um and the other thing that they have been known to do these private equity groups is selling the real estate the land under the hospital to another investor and then that investor jacks up the rent let's just say they were paying 10 000 a month and now it's you know 50 000 a month and that wasn't in their budget to do that and so they're really for some bankruptcy, which is really impacting these communities. It's just heartbreaking. Do you have any idea when did private equity groups start purchasing hospitals? Is this something new? Has it been going on for a while? At least a decade, probably a little bit longer. I think one of the ones I was writing about in upstate New York was they had bought these hospitals in 2010, And then these changes started just squeezing, you know, and making all these changes.
[53:51] It's just devastating. Yeah. Yeah. They're not in it for us. No, no. And it seems like they should be, meaning the hospitals. Yeah. Yeah.
Conclusion and Hope for the Future
[54:05] Well, Julie, you are such an incredible wealth of information. And I really hope if you're enjoying this conversation, all the great things that Julie has to say, all the gems, little nuggets, I would highly encourage you to get her book, Surviving Your Hospital Stay. Where's the best place where somebody can get a hold of your book and also follow you and all your great work?
[54:32] Thank you. Yeah, my book's on Amazon. And then my website, drjuliesemers.com. And then all my socials are drjuliesemers. I would like to leave your audience with a last thought of hope. Please. I know everything we've talked about is just gloom and doom. And it truly is, but I have hope. Otherwise, I wouldn't be doing what I'm doing. I honestly believe that we, as the healthcare care participants can become informed, can become educated. And when we let the healthcare team know we're invested, we're interested, we're partnering, we've got to change the culture. And therefore, we won't be dismissed. We won't be gaslit. We won't be, we'll be treated as, we're in it for the same reason. We want that patient to come home to us. And of course, the hospitals and the healthcare teams want good outcomes, but we need to work together. So we need to reset. Yeah, yeah. Very well said. And I love that you ended on that hopeful note. And yeah, patients and the medical community working together in a partnership, a shared partnership, right, to elevate everybody's health. Dr. Julie Siemers, thank you so much for joining me today on the PLANTSTRONGPodcast. Appreciate your time. Appreciate your wealth of information. And I wish you all the best.
[56:01] Thank you so much. Yeah, yeah. Okay, give me a little PLANTSTRONG fist bump on the way out, ready? Boom. Where's your fist? There it is, boom.
[56:12] Thank you, Dr. Siemers I know that it can be scary to think about these situations that we discussed, but this is why I am so grateful to Julie and her important work that empowers patients and their families to navigate the complexities of the healthcare system safely. Her book, Surviving Your Hospital Stay, A Nurse Educator's Guide to Staying Safe and Living to Tell About It, is available wherever books are sold. And I'll be sure to drop a link in the show notes today to make it super easy for you to order. Please, if you appreciated this episode, share it with your friends and loved ones. The information is just too important not to share.
[56:59] And while you're at it, always remember to always keep it plant strong. See you next week. The Plant Strong Podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn, Jr. And Anne Crile Esselstyn. Thanks so much for listening.
