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.