A hospital is a place where miracles happen, where human hands join science and technology to fix broken bones, remove cancerous tumors, and battle all manner of nasty diseases.
At the same time, hospitals can be intimidating and downright scary: Long sterile corridors full of gurneys and workers in identical scrubs, open doors revealing hapless patients, some of whom will not go home. It is estimated that nearly 100,000 hospital patients each year die from medical errors. Yet most common medical errors can be prevented when patients are well-informed and, along with a trusty advocate, monitor their care every step of the way.
If you are facing hospitalization for a surgical procedure or longer-term medical care, you owe it to yourself to learn as much as you can. If you are fully prepared, your hospital experience can do what it is supposed to do: Put you back on the road to good health.
One of the most important steps you can take is to ask a family member or friend to serve as your health care advocate, accompanying you to the hospital and representing your wishes. Then, if you should become confused or your judgment is impaired by your health condition, you can be confident that someone is standing up for your rights and best interests.
Here are more guidelines to help you gain control of your medical care and relieve some of your anxiety about impending hospitalization. From the moment you learn you are facing hospitalization of any kind or duration, you should be asking your doctors questions.
Before you go: ask questions.
- About your condition: What is my diagnosis? Why am I being hospitalized? Will I be undergoing more tests? What kinds of treatment will I receive? What are they for? Will they be painful? What is the expected outcome? How long will I have to stay?
- About the hospital: Where will I be going? How can I learn about the credentials and reputation of this hospital? Where does it rank in our community? Is it a teaching hospital? Who will be in charge of my care – my own primary care physician, or a hospital specialist (known as a “hospitalist”)?
- About medications: Can I take my regular medications while in the hospital? Will I be taking new medications too? How will the hospital staff know about allergies and side effects that I have experienced? If I am in pain, will I get pain medication?
- About after-care: What happens when I go home? Will I need nursing care or a home health aide? Will I be on a special diet? What about physical therapy? How long before I can resume my normal routine?
If you are having surgery, you will have even more questions. Before you decide on a surgeon, no matter how highly recommended, do some research into his or her track record. Ask: How many surgical procedures of this kind have you done? What is your success rate? What is the general success rate of this kind of surgery for my condition?
Ask your surgeon to walk you through exactly what will happen, from pre-op tests to preparing for the anesthesia to what goes on in the operating room to the recovery process. Ask the surgeon to explain what kind of anesthetic will be used, what the risks are, and who the anesthesiologist will be. Find out about the risks of this specific surgical process, the plan for minimizing risks, and the backup plan if something should go wrong. Discuss how long the surgery will take and how long it is likely to be before you wake up from the anesthetic. Make sure you understand what post-surgery care will entail so that you can line up outside help at home if you need it.
If you plan to involve an advocate in your hospitalization, be sure to share all of this preliminary information with him or her. Take copious notes so that, if there is confusion, you and your advocate will have in writing what you were told.
Prepare for your visit: Make a list.
- One well-known health care provider suggests that you prepare for a hospital visit just like you would get ready for any trip, making a list of things to do and what to pack. Here are some musts for your to-do list:
- Have legal documents in order, including “advance directives” (also known as “health care directives”). No matter how old you are or what your condition is, in the event that you are not able to communicate them yourself you should have advance directives to support the health care decisions that you have made. If you do not have advance directives already, consult an attorney about preparing these before you enter the hospital.
The most important documents are:
- A living will that puts in writing your specific wishes about the kind of extraordinary medical measures you do and do not want to receive. (This is different from a will or trust that designates heirs to your estate.)
- A medical power of attorney that designates an individual – a family member or trusted friend – to make medical decisions for you if you are incapacitated. This is sometimes called a durable power of attorney for health care, and is not the same as a financial power of attorney.
- A Do Not Resuscitate (DNR) order only if you do not want to be resuscitated if your heart stops beating.
- Comply with the instructions you have been given for pre-admission tests at the hospital. These may include blood tests, an electrocardiogram, and other procedures to establish your baseline condition before you are admitted.
- While you are there, ask questions about the hospital routine: When are meals served? What personal care, such as a daily bath, is provided? In addition to doctors and nurses, who else will be involved in your treatment? (If this is a teaching hospital, medical student interns, residents, and/or fellows may be part of your medical care team.)
- Make sure that the hospital has your complete medical records, and that they are up to date. Ask your doctor or surgeon who will transfer these records, and when. Then, when you are at the hospital for pre-admission tests and paperwork, ask to go over your records in case there is an error or omission. You may want to take with you your own copies of your records, just to compare. Good hospitals make this record verification part of their pre-admission routine.
- If it is not volunteered, ask for a copy of your rights as a patient. Hospitals are required by law to put in writing your rights to information about your health, and to spell out grievance procedures if you should have a problem that could not be solved during your hospital stay.
- Part of your pre-admission responsibility will be completing information about your insurance coverage. Before you do this, look over your insurance plan and then call your carrier to verify your understanding of what will be covered and what may not be covered. Be sure to take your insurance card with you to the hospital when you register for admission.
- Pack only the bare essentials you will need for your hospital stay, such as glasses or hearing aids. Do not pack the medications you take regularly – instead, make a detailed list of medication names, what they are for, the dosage, and how often you take them. Include on your list prescriptions, vitamins and supplements, and over-the-counter drugs. Note clearly medications to which you are allergic and drugs that have caused side effects.
After you are admitted: pay attention!
When you arrive at the hospital, bag packed and advocate at your side, your responsibilities are not over. As the saying goes, the devil is in the details: You and your advocate will need to monitor the details of your hospital care. Here are some tips:
- When your identification band is placed on your wrist, check it to make sure that your name, your doctor’s name, and all other information is correct. Every medical staff member who is caring for you should check your ID band every time to verify that you are the person who is supposed to get a medication or treatment. Do not remove your ID band for any reason.
- A good rule is, do not assume that anyone has checked your chart and is familiar with your health care needs. Continue to ask questions, ask medical staff to verify instructions in your chart, and remind them of critical information.
- When a new medication is brought to you, ask what it is called, what it is for, what the dosage is, how often you will take it, and if there are any common side effects.
- If you are being taken for tests or therapy, ask the same kinds of questions: What is this for? What is the procedure? How long will it take? Will it be uncomfortable or painful? What is the expected outcome? Will there be follow-up?
- To avoid potentially life-threatening germs, limit hugs with visitors and ask medical staff to wash their hands in your presence. Staph infections are common in health care facilities and hospitals, where patients have weakened immune systems. The best way to avoid staph and other infections is hand-washing.
Going home: understand the instructions.
A recent study indicates that about one third of patients discharged from the hospital do not understand what to do when they get home – even if they have received instructions from their doctor or the hospital.
Before you leave the hospital, after even a short stay, make sure you have in writing the steps you should take at home to facilitate your recovery. If you don’t understand exactly what these instructions mean, ask the medical staff to explain. Written directions should include:
- A copy of your prescriptions
- When and how to take the medications prescribed
- Options for managing pain
- How to clean, remove or replace dressing and bandages
- How long bed rest is advised
- Special diets and/or foods to avoid
- Ways to assess your progress
- Follow-up tests and/or therapy recommended
- After-effects that trigger a call to the doctor
- Possible emergency situations
If you have done your homework, you will have arranged for nursing care or home health care that may be necessary to put you on the road to recovery. If a family member is taking over this responsibility, make sure that he or she has a copy of your discharge instructions and is aware of the details of your surgery or hospitalization.
If you do not yet have the strength to manage your own home care, ask your advocate to talk with caregivers and set rules that will permit you adequate sleep and respite from well-meaning friends who overstay their visits. After even the best hospital experience, you need the time and space to recover at your own pace – and you deserve some peace and quiet!