Thursday, 2 May 2019

50 Secrets Hospitals Don’t Want to Tell You (But Every Patient Should Know)

No one looks forward to a health crisis, but our insights and tips will help you get better medical care, cut hospital bill costs, and get out of the hospital alive.

Pick a teaching hospital

“For complex surgical procedures, you’re generally better off at teaching hospitals, which usually stay at the forefront of health research. Medical students and residents ask questions, providing more eyes and ears to pay attention and prevent errors. Teaching hospitals have lower complication rates and better outcomes.” —Evan Levine, MD, a cardiologist and the author of What Your Doctor Can’t (or Won’t) Tell You

Beware freestanding ERs

“Those freestanding ERs popping up all over? They typically don’t have anywhere near the resources of hospital ERs, yet they cost just as much. Go there for small bumps and bruises. For something serious (chest pain, a badly broken bone), get to a trauma center where specialists and surgeons work.” —James Pinckney, MD, an ER doctor, founder of Diamond Physicians in Dallas, Texas.

Shop around for rehab

“If you’re being released for rehab, shop around for a place that has experience with your condition. We found that rehab facilities that handle more than two dozen hip fractures a year were more than twice as likely to successfully discharge seniors within a month as less experienced facilities were.” —Pedro Gozalo, a public health researcher at Brown University in Providence, Rhode Island. 

Sanitize everything

“Superbugs live everywhere, and they can travel. Even if your doctor washed his hands, that sparkling white coat brushing against your bed can easily transfer a dangerous germ from someone else’s room. Ask for bleach and alcohol wipes to clean bed rails, remotes, doorknobs, phones, call buttons, and toilet flush levers. Wash your hands before you eat.” —Karen Curtiss, author of Safe & Sound in the Hospital: Must-Have Checklists and Tools for Your Loved One’s Care.

Join the conversation

“Ask your nurses to do a ‘bedside shift change.’ This is when they share information in your presence instead of at the nurses’ station. You can better correct any errors. [Studies show it also improves communication and care.]” —Karen Curtiss. 

Don’t be a distraction

“Don’t interrupt the nurse when he’s preparing your medications. One study found that the more times you distract him, the greater the likelihood of error. [Each interruption was linked to a 12 percent increase in errors.]” —Sally Rafie, a hospital pharmacist with the UC San Diego Health System.

Ask what your doctor will be doing

“The surgeon who performed the best in our complication rate analysis said he and his partner drape their patients, do the whole operation, and close the incision themselves. He said, ‘I just know nobody is going to do it as carefully as I’m going to.’ Check whether your doctor will be doing your entire procedure and whether she will do your follow-up care.” —Marshall Allen, a reporter who covers patient safety for ProPublica, a nonprofit news outlet. 

Nurses are overwhelmed

“Hospitals often force nurses to handle more patients than they should—even though studies show if your nurse is responsible for fewer patients, they have better outcomes. California is the only state with hospital-wide minimum nurse-patient staffing ratios. Researcher Linda Aiken at the University of Pennsylvania found that each extra patient a nurse has above an established nurse-patient ratio made it 7 percent more likely that one of those patients would die.” —Deborah Burger, RN, copresident of National Nurses United. H

Administrators make big bucks

“Top administrators at U.S. hospitals are paid extremely well. CEOs make $400,000 to $500,000 a year, not including benefits like stock options. Administrative expenses eat up as much as 25 percent of total hospital expenses we pay for—much higher than in other countries.” —Cathy Schoen, executive director of the Council of Economic Advisors at the Commonwealth Fund, a foundation that focuses on health care. 

Doctors are incentivized to overtreat

“I hear from surgeons all the time whose bosses are basically beating on them to do more operations. While some hospital systems have moved to flat salaries, most still provide bonuses for more volume. Doctors have an incentive for over-treatment.”  —Marty Makary, MD, MPH, a surgeon and the author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.

You may unknowingly pay for out-of-network care

“Even if you’re careful to choose a hospital and a surgeon that are in network, there’s no guarantee that everyone involved in your care at the hospital is also in network. The radiologist, anesthesiologist, pathologist, and even the assistant surgeon could be out of network, and—surprise!—you’ll be billed at a much higher rate. [Some states, including New York and California, now have laws to prevent this from happening.]” —Cathy Schoen. 

Ask if you’ll be admitted

“You can stay overnight in the hospital but never officially be ‘admitted.’ Instead, the hospital can say you are there ‘under observation.’ That can be tricky for seniors because if they’re then sent to a nursing home for rehab, Medicare won’t pay for it unless they were actually admitted. Always ask whether you’re admitted.” —Deborah Burger, RN.

Hospitals side with doctors

“The hospital is incentivized to keep doctors happy. Surgeons bring in patients, who bring in dollars. If a patient has a complaint about a doctor or if a doctor has a high complication rate, the hospital’s financial incentive is to protect the doctor.” —Marshall Allen. 

Specialists quietly pad your bill

“Less-well-trained physicians will call in an abundance of consults to help them take care of the patient. If those specialists check on you every day, your bill is being padded and padded. Ask whether those daily visits are necessary.” —Evan Levine, MD.

Ask how to recover faster

“Since each day in the hospital costs $4,293 on average, one of the best ways to cut costs is to get out sooner. Find out what criteria you need to meet to be discharged, and then get motivated, whether it’s moving from the bed to a chair or walking two laps around the hospital floor.” —James Pinckney, MD. 

Bring your own meds

“It’s a lot cheaper—and usually OK—to bring your own medicines from home, but the hospital pharmacy will have to check them to verify they are what the bottle says. Just ask your doctor to write the order.” —Michele Curtis, MD, an ob-gyn in Houston, Texas. 

Check, check, check your bill

“Eight out of ten hospital bills we see contain an error, so check your bill carefully. You may identify a drug you didn’t take. Or you know that you discontinued a treatment on Tuesday, but you were charged for Wednesday. The number on the bill is only a starting point. Try to negotiate for 35 to 50 percent off the charges.” —Pat Palmer, CEO of Medical Billing Advocates of America. 

Second-guess tests

“Fifteen to 30 percent of everything we do—tests, medications, and procedures—is unnecessary, our research has shown. It’s partly because of patient demand; it’s partly to prevent malpractice. When your doctor orders a test, ask why, what he expects to learn, and how your care will change if you don’t have it.” —Marty Makary, MD. 

Hospitals are becoming more like hotels

“Hospitals worry about losing revenue to retail clinics, urgent-care centers, and private surgery centers. To attract patients, they try to appear like hotels. They have waterfalls, pianos, and big windows. Instead of hiring people with backgrounds in health care, they’re bringing in people with experience in retail and five-star hotels.” —Bill Balderaz, a health-care IT consultant. 

We’re not prepped for Ebola

“Hospitals say, ‘Don’t worry. We’re prepared for a serious disease like Ebola.’ But nurses on the front lines treating these patients are scratching their heads and thinking, We are not prepared at all. We are fighting to get the right equipment and training to take on these infectious diseases.” —Karen Higgins, RN, copresident of Nurses United.

Hospitals are getting violent

“There is more violence than ever before. Nurses have been attacked, bitten, spit on, and choked. It’s partly because hospitals are no longer prescribing pain meds to addicts, and addicts can get very aggressive. It’s also because our mental health system is broken, so some of those people are coming into the hospital and acting out.” —John M. White, a hospital security consultant. 

We’ve seen it ALL

“We see crazy things. I had a patient run buck naked into the ER waiting room. A patient asked me out while I was holding a basin, catching his vomit. We pull bugs out of people’s ears regularly.” —An ER nurse in Dallas, Texas. 

Hospitals cut chaplains to save money

“Spiritual care is not a profitable area for hospitals, so it gets cut. The vast majority don’t have enough chaplains, and some U.S. hospitals today don’t have chaplains at all.” —Rev. Eric J. Hall, CEO of the HealthCare Chaplaincy Network, a New York–based nonprofit. 

We bet on (or against) you

iStock/Scott Kochsiek
“Hospital staffers have placed bets on patients. Guess the Blood Alcohol is a common game, where money (or drinks) changes hands. Others try to guess the injuries of a patient arriving via ambulance. Surgeons have been observed placing bets on outcomes of risky procedures.” —Alexandra Robbins, author of The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital.

VIP patients can affect your care

“In many hospitals, VIP patients get special treatment. They may stay in special areas or have a VIP notation on their chart, which means that whenever their bell goes off, we are expected to make that patient’s request a priority, whether it’s ‘I need some water’ or ‘Can you get me some stamps?’ Hospitals don’t add more nurses; they just take away from the care everybody else gets.” —Deborah Burger, RN. 

Surgeons multitask major operations

“Your surgeon may be doing someone else’s surgery at the same time as yours. We’re talking about complex, long, highly skilled operations that are scheduled completely concurrently, so your surgeon is not present for half of yours or more. Many of us have been concerned about this for decades. Ask about it beforehand.” —Marty Makary, MD. 

Electronic paperwork annoys us

“Most of us hate electronic medical records systems. We don’t like that we have to click off boxes instead of focusing on the patient. The choices they give us to click on don’t give the doctors a real understanding of what we’re doing. A lot of things get missed.” —Karen Higgins, RN. 

Our priorities have changed

“Because Medicare has put more emphasis on the results of patient satisfaction surveys, hospitals are pushing us to emphasize customer service. It makes me worry we will do what we can to make people happy in place of what we should. To say that you need to focus on getting this person’s dinner right even though your other patient needs his chemo hung—that’s not right.” —Theresa Brown, RN, author of The Shift. 

Managed-care companies dominate our time

“The amount of time I spend on the phone talking to doctors working for the managed-care companies is, in my eyes, a complete waste of time. This morning, I spent 30 minutes explaining why I’m giving a patient a particular medicine. Those doctors don’t know who the patient is, yet I have to persuade them to allow me to do what I believe is in the best interests of the patient.” —Sam Klagsbrun, MD, executive medical director of Four Winds Hospital in Westchester County, New York

Be detailed about your meds

“Bring a clear, printed list of exactly what medications you take at home and when you take them. Don’t just say ‘daily:’ We need to know if you take them at night with dinner or when you wake up.” —Kevin B. Jones, MD, a surgeon and the author of What Doctors Cannot Tell You: Clarity, Confidence, and Uncertainty in Medicine. 

Admitted? Log everything

“Keep a notebook. Write down your questions, log who’s coming into your room, and track conversations with different doctors. It’s easy to get confused and disoriented in the hospital. It will also be helpful once you get the bill to have a record of who saw you and when.” —Deborah Burger, RN.

Bring your own toiletries

“Hospital toiletries are awful. The lotion is watery. The bars of soap are so harsh that they dry out your skin. There is no conditioner. The toilet paper is not the softest. Come with your own.” —Michele Curtis, MD.  

We lose money if you’re readmitted

“Hospitals used to not care about you once you were discharged. But under new rules, they face financial penalties if you are readmitted within 30 days. So now you may get a call from a nurse case manager a day or two after you’re discharged asking if you have any questions, checking if you got your prescription filled, and making sure you have transportation to your follow-up appointment.” —John W. Mitchell, former CEO of three hospitals.

We track your data—for you

“Some places use big data to improve patient satisfaction. We take all the information we have on you—age, ethnicity, health conditions, ZIP code, profession—and cross-reference it to find similar patients who have already filled out satisfaction surveys. Based on what we know about those patients, we try to figure out your preferences: how often you want nurses to assess you, how much time you like the doctor to spend with you, and what you may want in your room. We’ve seen a significant boost in patient satisfaction.” —Bill Balderaz. 
We can monitor you from a distance

“Hospitals try to lower the number of patients readmitted through remote patient monitoring. They may have you wear a monitor that tracks your vitals and alerts your team if they go out of range. They may ask you to download an app that reminds you to take your pill. If you don’t mark that you’ve taken it after a few reminders, a nurse calls.” —Bill Balderaz. 

Being transferred? Speak up

“If you go to a smaller hospital and it has to transfer you to a different medical center, demand that it ship you to the closest one that can handle your care. What’s happening is that community medical centers are sending patients instead to the big hospital that they’re affiliated with, even if it’s farther away. It happens even when a patient is bleeding to death or having a heart attack that needs emergency care.” —Evan Levine, MD.

Stay with your loved ones

“Don’t let loved ones spend the night alone in a hospital. It’s important someone is there if they get confused or need help getting to the bathroom or if their breathing pattern changes. If the hospital has restrictive visiting hours (many are eliminating them), ask if it will make an exception.” —Michele Curtis, MD. 

Hospital food could make you sick

“Don’t assume the food is what you should be eating. There’s no communication between dietary and pharmacy, and that can be a problem when you’re on certain meds. I’ve had patients on drugs for hypertension or heart failure (which raises potassium levels), and the hospital is delivering (potassium-rich) bananas and orange juice. Then their potassium goes sky high, and I have to stop the meds. Ask your doctor whether there are foods you should avoid.” —Evan Levine, MD. 

Request a furry pal

“If you love animals and miss yours, inquire if the hospital has a program for service pets to come and visit.” —Michele Curtis, MD. 

Schedule surgery early in the week

On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other diagnostic services may be unavailable. If you’re having a major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend.  —Roy Benaroch, MD, a pediatrician and the author of A Guide to Getting the Best Healthcare for Your Child. 

Go ahead, hydrate before surgery

“Many hospitals say no drinking or eating after midnight the day before your surgery because it’s more convenient for them. But that means patients may show up uncomfortable, dehydrated, and starving, especially for afternoon surgery. The latest American Society of Anesthesiologists guidelines are more nuanced: no fried or fatty foods for eight hours before your surgery and no food at all for six hours. Clear liquids, including water, fruit juices without pulp, soda, Gatorade, and black coffee, may be consumed up to two hours beforehand.” —Cynthia Wong, MD, an anesthesiologist at University of Iowa Healthcare 

Too much rest could impede recovery

“Get up and move. Walk the halls, walk to the cafeteria, go outside. It will help you avoid blood clots, and patients see psychological benefits. One study found that older patients who get out of bed and walk around reduce their stay by an average of 40 hours.” —Roy Benaroch, MD. 

Take notes, especially at discharge

“One study found that patients forget 40 percent to 80 percent of what doctors and nurses tell them, even if they’re nodding their heads. Have someone with you to take notes or tape-record what the doctor says on a smartphone. (Ask, ‘Do you mind if I tape-record this?’) The most critical time to record is at discharge, when you receive crucial information about medications and next steps.” —Karen Curtiss. 

Get your papers right away

“Get copies of your labs, tests, and scans before you leave the hospital, along with your discharge summary and operative report if you had surgery. It can be shockingly difficult for me to get copies of those things. Even though I have a computer and the hospital has a computer, our computers don’t talk to each other.” —Roy Benaroch, MD. 

Request a full night’s sleep

“If you’re feeling good and you are stable, ask your doctor whether you can sleep undisturbed between midnight and 6 a.m. I can write a note directing the nurses not to wake you up to check your vital signs.” —Michele Curtis, MD.

Schedule your follow-up before you leave

“Before you leave the hospital, demand that your follow-up appointment be already scheduled. I’ve found that is the single most effective strategy hospitals can use to reduce your chance of readmission, but it still rarely happens. Make sure you’ve been connected to the next person who will take care of you.” —Elizabeth Bradley, PhD, a professor of public health at Yale University. 

Try to be patient in the ER

“Emergency rooms used to have just curtains between the patients, so they could hear the chaos. As a result, I think they were a lot more understanding about delays. Now most hospitals have individual ER rooms that are very isolated. When patients get upset that it took me 20 minutes to come back to their room, I often wish I could tell them that I wasn’t sitting out there doing nothing. I was comforting someone who just lost a family member.” —An ER nurse in Texas. 

We never forget devastating moments

“My worst moment ever was on New Year’s Eve in 2008, when the code-blue pager went off. A baby we had operated on had stopped breathing. Ten of us were frantically doing everything possible, but we couldn’t resuscitate her. I had to tell her parents that their firstborn daughter had died. I was up all night grieving with them. Every New Year’s Eve, I think about them.” —James Pinckney, MD. 

We know your treatment is overpriced

“One time, I ran into a patient I had performed a simple appendectomy on. He thanked me for saving his life, then told me it almost ruined him because he couldn’t pay the bill. Four hours in the hospital, and they charged him $12,000, and that didn’t even include my fee. I showed his bill to some other doctors. We took out an ad in the newspaper demanding change.” —Hans Rechsteiner, MD, a general surgeon in northern Wisconsin.

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