Maggie McKay (Host): If you or a loved one has ever been in the hospital, you probably know how important it is to have someone with you to help navigate the process on your behalf. Today, Dr. Umair Jabbar, Co-Chair, Readmissions Reduction, Cook County Health, will explain why a patient advocate is so crucial.

Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Umair Jabbar about Collaboration, Not Conflict: Advocating effectively for you and your loved ones during hospitalization. Thank you so much for joining us today, Dr. Jabbar.

Umair Jabbar, MD: Thank you, Maggie, for having me.

Host: So, let's just start with what is a patient advocate and how can they help? What does it mean to be an advocate for yourself or a family member during hospitalization?

Umair Jabbar, MD: Yeah. So, a patient advocate really can be anyone. So, there could be formal advocates like we have at Cook County that really provide recovery when some things are not going right and the patients feel like they need to reach out. Maybe their room isn't cleaned, and no one's addressing it or they're having trouble communicating with their medical provider. So, we have formal advocates available to help patients get their needs addressed, and then, informal advocates as well. So, you have your family members, we have medical students in our hospital as well, and they can act as advocates, anyone that can address Issues. Patients have feelings of exclusion and uncertainty. And if you think around those things, what are the things that are making me feel excluded, disregarded, powerless? And how can we help that? What can we do to ameliorate that? Anyone can advocate that. And then, also for uncertainty, you know, "I'm about to go home. I don't know how I'm going to do? You know, the hospital feels safer. How can I succeed?" Right? And an advocate would speak up towards those issues and help reduce that uncertainty.

Host: And how can I prepare myself or my family member for a hospitalization?

Umair Jabbar, MD: So, one of the most important things I think you can do is, you know, come prepared about your own health history. The more empowered you are, the more you can advocate for yourself. So, what are the medications you're taking? Because sometimes there's a disconnect between what we've prescribed and what you might have at home. If you go to other health systems, you know, having access to those records either through an electronic portal, that can certainly help, you know, reduce the amount of tests that we do. That can save you money, save the inconveniences of undergoing repeated testing. Talking to your family members about what are your preferences for care, end-of-life wishes if you have a chronic illness that's progressing. "What if I were sicker, what are my priorities? You know, if I end up getting sicker and going to the ICU, you know, would I want to be aggressively treated, put on the ventilator, or would I want more natural progression of the hospital stay?"

So, those are important things I think to address as well as just basic necessities, you know, "I'm bringing my phone charger, bringing contact information for my family members." So that in case you're in a state that you're confused, we can reach out to your family members and learn a little bit about you and what's been going on with you.

Host: My son always makes fun of me because I print everything out and I bring a folder, even when we travel. Because you know what? If you lose your cell phone, or it goes dead, the battery, you're out of luck. So, I say, like when you go to the hospital, I have a folder. It's not thick, but it has everybody's contact numbers. And he's like, "Oh mom. You don't need to print it. It's on your phone." I don't think you can be prepared enough. I really don't. And like you said, your wishes. So even if you're overprepared, it might be helpful, because there are things you never think of until you're there and then it's too late. So, what are some common discussions around invasive procedures, tests, or complex medical decisions that sometimes are not sufficiently covered and should be asked?

Umair Jabbar, MD: Yeah, absolutely. So, I mean, whenever we're doing testing procedures, we always go over, you know, what is the test, what does it entail, why we're doing it, what are the risks of it. But I think oftentimes, we don't volunteer, and patients sometimes are not empowered to ask about, you know, "What if I do nothing? What are my alternatives?" And that's also important. "What if I wait? give it a little bit of time?" We sometimes say a tincture of time sometimes helps things. So, those are, I think, important things to also bring up whenever you're talking about anything that might be a little bit more invasive, a little bit more involved, so that can help you make a much more informed decision and then, you know, meet your own preferences. "Okay. This is what my medical providers would like to do. These are the alternatives." I think I would prefer that as long as it's acceptable to them and, you know, "What are the consequences if I choose to go down there?"

Host: And Dr. Jabbar, what are some hazards of hospitalization? How can patients and their loved ones help mitigate them?

Umair Jabbar, MD: Yeah. I think the biggest hazard we see is decline during the hospitalization. So, we notice that in the literature that a third of patients will have a new deficit in terms of their activities of daily living, just basic necessities of what you're able to do, like feed yourself, bathe yourself. So, a third of elderly will have that and lot of that has to do with, you know, reduced ambulation, poor sleep, deconditioning. So, getting out of bed in the hospital is very important. It could prevent some of the other hazards that we see, you know, such as getting blood clots in the hospital, developing pressure sores. So, those are some of the things as well as, you know, just making sure that your healthcare providers are washing their hands. Some patients will catch, you know, infections within the hospital. So, making sure that you're advocating on behalf of yourself, for your family members that, you know, it is our duty to wash our hands. That's another way as well that you can advocate.

Host: I read once that doctors' ties carry like tons of germs. Have you ever heard that?

Umair Jabbar, MD: Yeah. So, I mean, there's some literature out there that supports that. But, you know, the vast majority of patients do get infections from within their own bodies, but certainly there are things that we also can do to reduce some of those risks, such as some of the environmental things that we do, cleaning different areas, and protecting ourselves and protecting our patients as well.

Host: So, what's the typical daily workflow for healthcare providers? And how best can we leverage that knowledge to help communication between patients and their medical providers?

Umair Jabbar, MD: Yeah. So in a typical hospital most of the physicians round in the morning, so generally before 11:00. I'm not a surgeon. So, the surgeons rounds much earlier than I do and that's why I didn't choose that route. But the surgeons will round somewhere anywhere between 5:00 to 7:00 a.m. And then, medical doctors typically rounding anywhere between 7:00 to 9:00 a.m. And knowing that it's important to be there at the time of rounds, because again, then you get to see what the plan is for the day, right? So, what are the tests your doctors are thinking about? They can give you an idea of what the agenda is for that day. They might be a little bit rushed, but they can give you some sense of, "Okay, what's the plan?" And later on in the afternoon is when things to calm down. You know, we've gotten the things that we wanted to order enacted, and then we have time to kind of come back and go over in more details. Sometimes we do end-of-life discussions at that time. We do teaching, education about your health and how do you manage your own condition when you go home. So, afternoon's a better time often for those kinds of discussions. But it's important, I think, to be present on rounds if at all possible, and with your family members as well, because sometimes, when you're sick, you don't understand sort of many of the things that are being talked about. So, it helps multiple people hear that and then, oftentimes the patients might not ask or the family members ask really good questions about the care and what we do when we go home.

Host: Can there ever be too many family members? Because once my mom was in the hospital and she has five kids and we're all there. And I'm like, "This is too many cooks in the kitchen."

Umair Jabbar, MD: Yeah. That's a good point. What we try to do is if there's a lot of family members, it's very nice to see that, frankly, right? So, you get to see that's a very supportive family. They're all engaged in the patient's care. But to facilitate efficiency in care, it helps to have a one appointed family member as the family spokesman who we hear from what the family is thinking. But also, when we need to convey information, we can also go through that family member and they can convey to the rest of the family. So, that helps facilitate bidirectional care.

Host: And doctor, how can we advocate for ourselves and our loved ones to reduce the cost of care? Is that even a thing?

Umair Jabbar, MD: There's definitely options. I think we don't often think about those. But at the time of discharge, you know, we have the option to look at your formulary, what insurance do you have, and pick things that will have a lesser copays. Sometimes we do tests in the hospital that really could be done as an outpatient. You know, after you've left the hospital, you come back for an appointment, and those tend to cost a lot less than had you gotten them done in the hospital. So you kind of have to think about, you know, what other tests do I need now for my doctors to make a decision? And if I don't get them now, they might delay my care. You know, what are the things that I can put off? And are we doing it just because you're here or it's just convenient and that that might raise your hospital bill? So, asking about those things. And it might prolong your hospital stay, frankly, as well, right? So, you know, those are some of the ways you can reduce the cost of care and as well as always involving your insurance. If we talk about something, it's a good idea to kind of run it by your insurances and say, like, "My doctor started thinking about this. Is this something that's going to be covered, because it's something very expensive?" It's probably a good idea to check with them first.

Host: Can you do that before you have the surgery, or you just don't know what's going to be needed after?

Umair Jabbar, MD: So typically, most hospitals have a process where we submit what we'd like to do prior to the surgery to get that approval. But certainly, you can also inquire about that as well. They might want more details. But generally, you can ask about these things.

Host: Dr. Jabbar, what are some strategies for overcoming language barriers to ensure that patients receive adequate care and support? Because I imagine that happens a lot.

Umair Jabbar, MD: It does actually. So, most physicians and medical providers will tell you there's a big difference between having a live interpreter versus having an interpreter that you're communicating through the phone or through an iPad. They're subtle context clues that really help. And our live interpreters are great. They're not always available, particularly for elderly family members, you know, it really does help to have a live interpreter. So if you're feeling that your preferences are not being met, there's a discontinuity in how we're taking care of you, it's best to ask for a live interpreter and we can certainly accommodate that in many cases, especially for the common languages such as Spanish and Polish. And then, we get that benefit of the cultural competency that comes with some of our live interpreters. And they actually see the patients multiple days. You get some of that historical information as well. Sometimes before we go into a patient's room, the interpreter will tell us that, "You know, I just had this conversation with a different medical provider with this patient," or "I saw this patient yesterday and this is what's going on." So, we get a lot of extra information that we may not get through our own interactions directly with the patient. So, it's very, very helpful. Having family members there that speak the language as well can also help us really understand what a patient might be trying to tell us. Though by no means is there an obligation to have the family there, we're required to have language interpretation available for all patients.

Host: And you mentioned going home. I mean, sometimes that can be a scary proposition. So, what are some ways I can ensure a smooth transition back to home?

Umair Jabbar, MD: So, it actually helps to ask about, you know, what are the home supports that are available? You know, insurance is the biggest variable in this, you know, what they'll cover, what they won't, right? So, asking about, "Okay, can I get coverage for a home aid that will help me bathe, cook, and clean?" And if you have family members that are doing that, that takes a lot of work. And do they need some respite? You know, do they need some relief from that work? It's intensive work, right? So, are those supports available through my insurance, through some of the governmental programs that are out there? What equipment might I need? Do I need a cane? Do I need a hospital bed? You know, those are some of the things.

I think also what eases the transition to for family members is to come in. And before you're about to go home, if you know you're going home in two days, come in and see what are our nurses doing, right? Our nurses, are they flipping the patient? Are they helping the patient bathe, cook, you know, use the restroom? And how are they doing that? What are they kind of doing? What is physical therapy doing to help the patient, you know, move and ambulate, right? So when you observe that you can practice that in the hospital. And that way, you're more confident when you get home and you reduce that sense of uncertainty. You know, catheter care, a lot of different things help by just coming to the hospital and seeing and observing and practicing, really.

Host: Dr. Jabbar, can you share any stories of families effectively advocating for themselves or their loved ones during hospitalizations?

Umair Jabbar, MD: Yeah. I had a recent case where a patient came to us who needed a semi-urgent surgery. And we were rounding, and the night doctors, my medical team, they saw the patient and the family members, and they reported to me on rounds that, you know, the patient and the family are very upset, warning me about the interaction that was about to occur because they were told that they need surgery, and they need surgery fairly quickly. So, we went in there and, you know, we tried to make sense of the situation. What are the family's preferences, values, right? And it wasn't really that they were being difficult. It was not at all. They were feeling that maybe that the medical staff wasn't listening to the patient. The family members really were the caretakers for this patient who couldn't speak for himself really. And the family member felt that we weren't really listening. So when we listened to the family member, she wasn't against what we were offering in terms of surgery. She just wanted to have more certainty that the surgery was needed. And we were able to figure out that if we do a biopsy first, we'll have more certainty that this is the diagnosis. And then, yes, the surgery certainly can proceed because it was a life-altering surgery. You know, the patient might have needed a breathing tube, might have needed a feeding tube after that. And, you know, for a family member to make that choice on behalf of someone who can't make that decision or can't advocate for themselves, that was a, you know, big deal.

So, that's where they were coming from. We were able to ascertain that and we were able to come up with a solution that really met the medical needs from our perspective, but also the patient's preferences that we were able to proceed with the surgery, everyone was on board with that. But you know, we were able to give the family some certainty, "Okay, this was the right course that we were suggesting." There was no harm done. The surgery was going to happen in two days anyway, and we were able to in the day between and get more certainty for the patient.

So, that was a very effective way for the patient and the family to advocate for themselves. And we were able to accommodate that once we understood where they were coming from.

Host: Right. I think it's so stressful for the family, because nobody wants to make a mistake. They want to communicate their loved one's wishes. And then, I think also, as a patient, sometimes you can feel so powerless. Like, everyone's talking about me and I'm the patient. All these things you've told us about that we've learned today are so helpful. Is there anything else you'd like to add that we didn't cover?

Umair Jabbar, MD: No. I would just recommend, you know, please feel free to speak up. And our institution is a teaching institution. So, you have a lot of people coming to see you. But in a way, that's a good thing. My standard joke that I tell my team, and luckily I have new teams, they laugh every time. But, you know, I say, for example, that all these people are seeing you, the patients come and say that, "I'm answering the same questions." But in a way, we learn more about you, right? If you have a student, a first-year resident, second-year resident come seeing you, they learn different things about you and we can take better care of you knowing that. And we joke that, you know, "You came at the right time, it's Memorial Day, we're having a sale in the hospital, you get five doctors for the price of one." The students have less patients, so talk to them, tell them your story and, you know, it really does help us, especially as the supervisors of some of the other doctors, to better take care of you. We want to take care of you. But, you know, sometimes we're not able to spend as much time as we would like because of how hospital sometimes operates. But, you know, we would love to know more about you and better take care of you and everything.

Host: That's right. Knowledge is power. The biggest thing I learned, I had no idea, the few times I've been in the hospital, that hospitals have advocates available for you.

Umair Jabbar, MD: We do. Yeah. So at Cook County, it's led by a great team, led by Denise Goody. They meet the patients in the morning. They hand out a quiet packet with the eye mask and some earbuds to help them sleep at night, because that's something that gets often affected and can impact health. And then again, they make themselves available. And when they call, I make sure I listen because at that point if they're being called, that means we might not have taken care of some things that we should have taken care of, and they really help us provide better care and find out things that we might not be aware of as physicians certainly.

Host: I always think, like, what about elderly who have nobody to be their advocate or somebody who's new to town, who doesn't know anybody? So that in itself is a great thing to know. So, thank you so much for sharing your expertise and giving this very useful information to us.

Umair Jabbar, MD: Oh, thank you. Happy to be on the program and help patients get better care.

Host: Again, that's Dr. Umair Jabbar. And if you'd like to find out more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast. Share and connect with us on social media. Stay tuned for more engaging discussions. Thank you for listening. This is Maggie McKay signing off from Total Health Talks. Stay well.