We ask every patient before wheeling them to the operating room, “Is there someone you’d like us to call to give updates?”
During the surgery, it’s customary for the operating room nurse to call the family every hour and let them know how things are going. When the procedure finishes, the surgeon talks with the family while the patient is still waking up from anesthesia. It’s not unusual that a whole family entourage surrounds the patient – the spouse, adult children, siblings, in-laws... However, occasionally, we see the opposite – a patient who’s by themselves and answers, “No, there’s nobody to call.”
Patients are required to bring a “responsible adult” with them to same-day procedures such as colonoscopies and cataracts. The companion gives them a ride home afterward and makes sure they’re safe while the lingering sedatives wear off. Many hospitals have a policy to cancel the procedure if the patient shows up alone. But now and again, we meet a patient who requests that we proceed, because they’ll never have anyone to bring. In these instances, we either do the procedure with no sedation, which can be uncomfortable or even traumatic, or admit the patient for overnight observation, which can be expensive and inefficient.
Having surgery alone is the ultimate level of loneliness according to a chart widely circulated on social media. These patients live alone, have no family nearby or available, and for one reason or another, are socially isolated. The problem is prevalent in Asian megacities where millions of people have migrated, in pursuit of work opportunities, leaving behind the social support networks of their rural hometowns. The needs of these patients have even hatched a new occupation in China; for a fee, the “patient escorts” act as temporary family members to offer guidance and emotional support.
As seen at our hospital in Springfield, there are solitary patients in America as well. Seeking medical care alone is especially daunting for the elderly who may be physically or cognitively impaired. The Census Bureau reports 38 million single-person households in 2022. The proportion of single-person households increases with age; 42% for those above age 65 and 58% among those 80 and over. The frequent and serious healthcare needs of the elderly magnify the problem.
Solitary patients not only present logistical challenges, but they’re also at risk for poor outcomes. People who live alone or are otherwise socially isolated, tend to miss appointments and postpone care, resulting in delayed diagnosis and treatment. When recuperating from surgery or hospitalization, the patient often relies on family members and friends for daily activities, transportation, and access to therapy services. Lack of this informal support system can double the one-year death rate of socially isolated patients following a critical illness as compared to socially connected patients with the same medical conditions.
If you’re such a solitary person, then how can you prepare for your health needs when you don’t have “someone” readily available?
The first piece of advice to consider is to plan ahead. Schedule your appointments and procedures well in advance so you can find someone in your network, maybe a co-worker or church friend.
Second, don’t be afraid to ask for help. Explain your situation to the provider team and ask for accommodations such as an additional night at the hospital or discharge to an inpatient rehab facility. You’re entitled to receive timely and safe care whether you’re alone or come with an entourage of people.
Third, weave in a formal support structure. Home care agencies provide “appointment companions” to accompany you to clinics and hospitals, similar to the patient escorts in China. Geriatric care managers are nurses or social workers who become a sort of “professional relative” to help you navigate healthcare and find ways to meet your needs. Most insurance doesn’t cover these services, so you’ll probably have to pay out of pocket.
Encouragingly, providers and hospitals are starting to notice the negative health effects of solitude. We hope more attention and compassion will be given to this group of patients, so no one falls through the cracks and suffers the physical and emotional ramifications of not having comprehensive care during and after hospitalizations.
Qing Yang and Kevin Parker are a married couple living in Springfield. Dr. Yang is an anesthesiologist. She received her medical degree from Yale School of Medicine and completed residency training at Massachusetts General Hospital. Parker has helped formulate and administer public policy at various city, state, and federal government entities, including the Illinois Department of Innovation and Technology and the Illinois Emergency Management Agency. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.
This article originally appeared on State Journal-Register: Patients navigating health care alone can't be afraid to ask for help