A hospital is driven by the goal of saving lives. It may range in size and service from a small unit that provides general care and low-risk treatments to large, specialized centers offering dramatic and experimental therapies. You may be limited in your choice of a hospital by factors beyond your control, including insurance coverage, your physician’s hospital affiliation, and type of care available.
Before entering a hospital, you should be aware of possible dangers. Well-known hospital hazards are unnecessary operations, unexpected drug reactions, harmful or even fatal blunders, and hospital borne infections. The Institute of Medicine recently identified three areas in which the health-care system, in general, and hospitals and their staff, in specific, often fall short: the use of unnecessary or inappropriate care (too many antibiotics), underused of effective care (too few immunizations or Pap smears), and shortcomings in technical and interpersonal skills . The greatest single danger that a hospital presents is infection, which is largely preventable.
What can lay people do to ensure proper and safe care while in the hospital? The following guidelines should be considered.
If you have a choice of hospitals, inquire about their accreditation status. Hospitals are subject to inspection to make sure they are in compliance with federal standards. Policies implemented in 1989 require the release of information on request to state health departments regarding a hospital’s mortality rate, its accreditation status, and its major deficiencies.
Before checking into a hospital, you need to decide on your accommodations. Do you want to pay extra for a single room? Do you want a nonsmoker for a roommate? Do you need a special diet? Do you need a place to store refrigerated medicine? If someone will be staying with you, will they need a cot? You should try to avoid going in on a weekend when few procedures are done. When you get to your room, you should speak up immediately if it’s unacceptable.
You need to be familiar with your rights as a patient . Hospitals should provide an information booklet that includes a Patient’s Bill of Rights. The booklet will inform you that you have the right to considerate and respectful care; information about tests, drugs, and procedures; dignity; courtesy; respect; and the opportunity to make decisions, including when to leave the hospital.
You should make informed decisions. Before authorizing any procedure, patients must be informed about their medical condition, treatment options, expected risks, prognosis of the condition, and the name of the person in charge of treatment. This is called informed consent. The only times hospitals are not required to obtain informed consent are cases involving life-threatening emergencies, unconscious patients when no relatives are present, and/or compliance with the law or a court order, such as examination of sexually transmitted diseases. If you are asked to sign a consent form, you should read it first. If you want more information, you should ask before signing. If you are skeptical, you have the right to post pone the procedure and discuss it with your doctor.
Authorization of a medical procedure may be given nonverbally, such as an appearance at a doctor’s office for treatment, cooperation during the administration of tests, or failure to object when consent can be easily refused. This is called implied consent.
You need to weigh the risks of drug therapy, x-ray examinations, and laboratory tests with their expected benefits. When tests or treatments are ordered, you should ask about their purpose, possible risks, and possible actions if a test finds something wrong. For example, the injection or ingestion of x-ray dyes makes body structures more visible and greatly facilitates a physician’s ability to make a correct diagnosis. However, dyes can cause an allergic reaction that ranges from a skin rash to circulatory collapse and death. Finally, you should inquire about prescribed drugs. You should avoid taking drugs, including pain and sleeping medication, unless you feel confident of their benefits and are aware of their hazards.
When scheduled for surgery, prepare for anesthesia. In rare cases general anesthesia can cause brain damage and death. One cause of such catastrophes is vomiting while unconscious. To reduce the risk, refuse any food or drink that may be offered by mistake in the 8 hours before surgery.
You need to know who is in charge of your care and record the office number and when you can expect a visit. If your doctor is transferring your care to someone else, you need to know who it is. If your doctor is not available and you do not know what is happening, you can ask for the nurse in charge of your case.
You should keep a daily log of procedures, medicines, and doctor visits. When you get your bill, compare each item with your written record. Insist on an itemized bill.
You should stay active within the limits of your medical problem. Many body functions begin to suffer from just a few days’ inactivity. Moving about, walking, bending, and contracting muscles help to clear body fluids, reduce the risk of infections (especially in the lungs), and cope with the stress of hospital procedures that add to the depression and malaise of hospitalization.
You should be alert. Throughout your stay, you can keep asking questions until you know all you need to know. According to some experts, the biggest improvement in health care has not been technological advances; it’s been patients asking questions. The more questions, the fewer mistakes and the more power patients have in the doctor-patient relationship
Selecting a Health-Care Professional
Choosing a physician for your general health care is an important and necessary duty. Only physicians are discussed here, but this information applies to the selection of all health-care practitioners. You must select one who will listen carefully to your problems and diagnose them accurately. At the same time, you need a physician who can move you through the modern medical maze of technology and specialists.
For most people, good health care means having a primary-care physician, a professional who assists you as you assume responsibility for your overall health and directs you when specialized care is necessary. Your primary-care physician should be familiar with your complete medical history, as well as your home, work, and other environments. You are better understood in periods of sickness when your physician also sees you during periods of wellness. Finding a primary-care physician, however, may be difficult. Of the 700,000 doctors in the United States, only 200,000 (less than 30%) are in primary care.
For adults, primary-care physicians are usually family practitioners, once called “general practitioners,” and internists, specialists in internal medicine. Pediatricians often serve as primary-care physicians for children. Obstetricians and gynecologists, who specialize in pregnancy, childbirth, and diseases of the female reproductive system, often serve as primary-care physicians to women. In some places, general surgeons may offer primary care in addition to the surgery they perform. Some osteopathic physicians also practice family medicine. A doctor of osteopathy (DO) emphasizes manipulation of the body to treat symptoms.
There are several sources of information for obtaining the names of physicians in your area:
Local and state medical societies can identify doctors by specialty and tell you a doctor’s basic credentials. You should check on the doctor’s hospital affiliation and make sure the hospital is accredited. Another sign of standing is the type of societies in which the doctor has membership. The qualifications of a surgeon, for example, are enhanced by a fellowship in the American College of Surgeons (abbreviated as FACS after the surgeon’s name). An internist fellowship in the American College of Physicians is abbreviated F ACP. Membership in academies indicates a physician’s special interest.
All physicians board certified in the United States are listed in the American Medical Directory published by the American Medical Association and available in larger libraries. About one fourth of the practicing physicians in the United States are not board certified. This may mean that a doctor failed the exam, never completed training, or is incompetent. It could also mean that the doctor simply has not taken the exam.
The American Board of Medical Specialists (ABMS) publishes the Compendium of Certified Medical Specialties, which lists physicians by name, specialty, and location. Pharmacists can be asked to recommend names.
Hospitals can give you names of staff physicians who also practice in the community.
Local medical schools can identify faculty members who also practice privately.
Many colleges and universities have health centers that keep a list of physicians for student referral.
Friends may have recommendations, but you should allow for the possibility that your opinion of the doctor may be different.
Once you have identified a leading candidate, you can make an appointment. You need to check with the office staff about office hours, availability of emergency care at night or on weekends, backup doctors, procedures when you call for advice, hospital affiliation, and payment and insurance procedure.You should schedule your first visit while in good health. Once you have seen your doctor, reflect on the following: Did the doctor seem to be listening to you? Were your questions answered? Was a medical history taken? Were you informed of possible side effects of drugs or tests? Was respect shown for your need of privacy? Was the doctor open to the suggestion of a second opinion?