Hospital Survival Guide

As a patient, you aren't as helpless as you might think.

A surgical sponge is left in an incision. The wrong leg gets amputated. These are the hospital horror stories that stick in our minds. But it's the commonplace ones that pose a far greater risk to the thirty million Americans entering the hospital each year.

One in 10 patients is discharged from the hospital with an infection he or she didn't have going in. Each year about 80,000 people die from such an illness. Studies show that even patients at the most prestigious hospitals receive the wrong drugs 2 to 3 percent of the time. In some hospitals, the number rises to 11 percent.

And if 95 percent of credit card bills were wrong, consumers would riot in the streets. But little protest followed a 1991 General Accounting Office survey revealing a 95 percent error rate on hospital bills.

But there's a dose of good news. A little awareness and some simple steps can make a big difference.

Doctors and hospitals make mistakes. But patients are mistaken if they think they can't do anything to help themselves.

Make Health a Priority

As a nation, we spend more time evaluating the mechanic who takes care of our car than exploring health care options. We often ignore health issues because we're afraid of bad news.

"It's a lot harder to find out something is wrong with your heart than it is to find out that your car needs a new transmission," says Joe Restuccia, Dr.PH (doctor of public health), a professor of health care and operations management at Boston University School of Management. Restuccia coauthored the section on hospitals for the book Health Care Choices for Today's Consumer.

Certainly a hospital stay is one of the most dreaded health care experiences. Feeling empowered while lying on a gurney is "a tall order," says Sherrie Kaplan, Ph.D., codirector of the Primary Care Outcomes Research Institute at the New England Medical Center in Boston.

Hospitals are designed to make you feel that you don't really know much, says Charles Inlander, president of the People's Medical Society, a national nonprofit medical consumer group in Allentown, Pennsylvania. But, he adds, assertive patients tend to spend less time in the hospital and recover more quickly.

Doctor's Orders

Have you ever just flipped through your hospital chart when no one was looking? Probably not. It, after all, belongs to the doctor.

For most, being a patient means being pretty passive, says Kaplan. Her research shows that during a 20-minute discussion, chronically ill women ask about four questions of their doctor. Chronically ill men, on average, don't even ask one.

Looking out for yourself in a hospital, in spite of feelings of vulnerability and intimidation, requires practice. Start by communicating more effectively with your doctor.

The doctor/patient relationship is a partnership, and no one says the patient can't be the managing partner. Ask your doctor what his or her definition is of an effective doctor/patient partnership. If the answer makes it clear that a partnership is impossible, says Kaplan, then move on.

Make your time count. Write down questions and other pertinent information about your illness before seeing a doctor. Skip the waiting room magazines and mentally review information you'd like to give and receive. This will help you respond more quickly as the doctor presents new information.

Check Out, Then Check In

If a hospital stay is a must, do some research. An unexpected and easy-to-obtain source of information is the hospital's own patient handbook. These documents are often overlooked but contain important information, such as patient rights, infection control policies, available services, and the procedure for registering complaints.

Choose a hospital with ample experience treating your particular ailment-especially if the treatment is highly technical. Compare the number of procedures and success rates with other hospitals.

Now, take a self-guided tour. Avoid visiting a hospital at meal times and during shift changes, usually 7 a.m., 3 p.m., and 11 p.m. Most hospital staffs are very busy then and won't have time to chat with you even briefly. Early afternoon and evening are ideal times for a visit.

Check for cleanliness, a knowledgeable staff, and whatever you personally find important, such as access to a quiet chapel.

If your doctor or insurance company disagrees with your decision, most insurance companies have an appeal process. Use it. The choices are there, says John Connolly, Ed.D., author of How to Find the Best Doctors, Hospitals, and HMOs for You and Your Family. "You just have to know how to exercise them."

Who's Doing What?

Before being admitted, discuss your treatment at length with your doctor. Take another person along to ensure you are getting accurate information. Ask for relevant written materials and establish a specific time to call if you have any additional questions. Make sure you understand what will be done, why it will be done, and what to expect after recovery.

When admitted, request a copy of your medical records to take home, and ask that a daily billing summary be sent to your room. Some hospitals may balk. State legislatures have legally required this access to your medical record in about half of the United States; and in most other states, laws don't specifically prohibit patients from having their full records.

Record everything from antibiotics to X rays in your personal hospital diary. Know, Connolly says, "who is doing what to you at all times--including what medication you're receiving or why you're undergoing a specific test. Reduce the risk of infection by politely asking any employee touching you, or your food, to wash his or her hands, or to put on a pair of fresh rubber gloves.

If concerns arise, contact your doctor or the hospital's patient advocate or ombudsman. If a problem persists, contact specific department heads or the hospital's top executive. Direct communication will usually be enough.

Paying the Bill

Connolly says complicated hospital billing systems are simply overwhelming. "Each piece of equipment, each service is generally delivered by a different person 24 hours a day," he says. A billing clerk attempts to decipher the hurriedly scribbled notes and numbered stickers representing each action.

This convoluted system shows the value of using your personal hospital diary and the daily billing statement to ease your own translation of the hospital bill.

Not paying for services you didn't use may sound like a no-brainer, but accounting errors can sometimes add other patients' charges onto your bill. Also, fees are typically imposed for every professional who enters your hospital room, but not necessarily deducted if you don't use the service offered, such as physical therapy. If an X ray is ever unusable or a blood test contaminated, the hospital--not you--should pay for taking another one.

Remember, it's the little things that mean a lot--of money.


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