How to Get Much Better Hospital Care

By Marie Savard M.D.
Bottom Line Health
August 2000

Managed care and rampant cost cutting have left many hospitals understaffed. Doctors are constantly rushed. Fewer nurses must care for more patients.

Result: Patients buzz for help with no response...get diagnostic tests by mistake...receive medication with no explanation.

You can still get superb care in the hospital-if you become your own health-care "manager." Seven things you must do...

• Have a friend or relative stay with you. A caring companion can get you water when you need it...help you to the bathroom...and command the attention of doctors and nurses when necessary.

  Your companion can also look after your interests at a time when you may be too weak to protect yourself. Your advocate can ask questions, take notes and clarify exactly what's being done-and why.

  If possible, call on more than one person for help. That's because round-the-clock company is best. Posted visiting hours are only guidelines-and they are meant for visitors, not health advocates. In fact, nurses often appreciate having an extra set of hands when they're too busy to help you themselves.

  Exception: Space is always tight in intensive care units. Having an extra person in the ICU may prevent other patients form getting the care they need.

• Identify a point person. On an average day, a hospital patient might talk with his/her primary doctor...surgeon and/or anesthesiologist...and an ever-changing cast of interns and residents.

  It's not uncommon for patients to get conflicting information from all these professionals. You need a point person who can sort everything out and answer your questions.

  Typically, that will be the attending physician. He's the doctor on record at the hospital as being in charge of your case.

  The attending physician coordinates your care. Depending on your medical problem, he might be your surgeon, cardiologist or internist.

  As soon as you've settled in your room, ask the nurse assigned to your case to identify your point person. Get his name, telephone number and pager number.

• Obtain your daily schedule. Each day, the nurses on your floor receive a "plan of care" listing tests you're scheduled for...meals ordered...and special instructions from your doctor. They also receive a separate list of all medications that have been ordered for you.

  Each morning, ask the nurse in charge of your care to let you see both these lists. Take notes on all important entries. It's the best way to ensure that mistakes don't occur, such as undergoing the wrong test or getting the wrong medication.

• Get to know the staff. You want the nurses, technicians and other staff members to see you as a real person-not just another face on the ward.

  Make small talk when staff members come to your room. Ask about their weekend's...families...interests. Introduce your friends and family to them. Above all, let them know that you appreciate their care.

• Get the sleep you need. Sleeping in the hospital is hard. The environment is noisy and unfamiliar. Even worse, staff members from different teams and services usually awaken patients every few hours for medication...blood pressure checks...IV adjustments.

  Ask your assigned nurse if all these tasks can be combined in one visit. Making arrangements ahead of time permits better coordination of your care and less interruption of your sleep.

• Don't put up with pain. Adequate post surgical pain management speeds healing and helps prevent stress and depression. Yet doctors often skimp on pain medication because they fear the possibility of side effects and addiction.

  The concern about addiction is misplaced. Adequate pain medication during hospitalization does not lead to subsequent abuse of painkillers.

  If you're in pain, alert the medical staff. Otherwise, they'll assume that the medicine you're receiving is effective. If your doctor or the nurses decline to help, request a consultation with the hospital's pain specialist.

• Get a copy of your discharge summary. After your stay, the hospital provides a summary of your treatment to your attending physician and any other doctors he designates. You should get a copy of this summary, too.

  The report will provide important information for any physician who treats you in the future. It lists the reason for your hospital admission, important test results and surgical findings, all medications prescribed and the recommended future plan of care.

  The summary is usually sent to your physicians two to three weeks after your discharge. Before you leave the hospital, give your primary-care physician a self-addressed stamped envelope. Ask him to send you a copy of the report when it arrives at his office.

  In the meantime: Before you leave the hospital, get copies of the results of all tests specifically related to your condition.

  If you were hospitalized for a heart attack, for example, this would include a copy of your electrocardiogram (EKG).

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