12 Ways to Stay Safe in Hospitals

Hospitals can save you, but they can also harm you. In my last two articles, I discussed recent research that shows how medical errors affect one in three hospitalized patients, and the 10 types of errors that happen.

So how can you stay safe in hospitals? Follow these 12 life-saving tips:

#1. Never go alone. Always bring someone else—a trusted family member or friend—with you. That person will be your primary advocate, and can serve as an extra set of eyes and ears to help make sure you are safe. (This tip applies to routine doctors’ appointments too; always bring your advocate with you.)

#2. Determine, in advance, the goals of the hospitalization. Before you go to the hospital, ask your doctor why you need to be hospitalized. Is it necessary, or is outpatient care possible? What is the goal of the hospital stay? How often will that goal be assessed? Can you choose which hospital to go to, and when you should go? Rarely is the need for hospitalization so emergent that you can’t get these answers and discuss them with your doctor in advance.

#3. Prepare. Bring all the things you would normally bring with you to a doctor’s appointment, including a list of your medical problems and allergies. Don’t assume that the hospital will have your records. It’s very important to bring all the pill bottles that you take so that there will be no mistake about what dosage and how often you take your medications. Keep your main doctor’s phone number and your advocate’s phone number handy (though your advocate should be going with you to the hospital).

#4. Meet your care team. Find out who is in charge of your care: is it your regular doctor or a hospitalist doctor? Introduce yourself to her, and to your primary nurse. Meet the patient care tech, the nursing assistant, and the other members of your healthcare team. Tell them about yourself, and find about them. The more they get to know you as a person now, the more they will help to answer your questions later. Your advocate should also get to know your care team.

#5. Know who to call for help and how. Who will be the night-duty doctor and nurse, and how can you reach them? If you are in trouble, or if your advocate sees you’re in trouble, how will you get help? Many hospitals have a “rapid response team” or a “code team” that come to assist in emergency situations. Can your advocate activate this team himself?

#6. Ask about every test done. Don’t just consent to tests. They all have risks, so ask about them. Why is your blood drawn every morning—what is the purpose? Why are you getting the CT scan? You should discuss every test with your doctor in advance of doing them, and have a thoughtful discussion about risks, benefits, and alternatives.

#7. Ask about every treatment offered. If you’re being started on a new medication, ask about what it is, what the risks are, what the alternatives are, and why you need it. If you’re told you need a procedure, make sure you discuss it with your doctor.

#8. Keep a record of your hospital stay. Your advocate may need to help you with keeping a careful record. This includes your tests (make a note of what you get done and ask about the result), medications (write down when each medication is given and double-check it’s correct), and providers who come to see you (write down names of specialists and their recommendations). A detailed record helps to prevent mistakes, coordinate your care, and keep you on track.

#9. Attend bedside rounds. Doctors and nurses usually have rounds at least once a day to discuss their patients. Find out when rounds happen and ask if you and your advocate can attend. This is your time to find out what’s going on with your care. Prepare questions to ask during rounds.

#10. Know your daily plan. Rounds are a good time to ask about what is happening that day. Are you doing more tests? More treatments? Are you on track, or did something unexpected happen? When can you expect to go home?

#11. Keep your eye on infection control. If someone comes into your room, ask him to wash their hands. If someone is doing a procedure on you, ask her to follow an infection control checklist. Hospital-acquired infections kill 100,000 people every year, and you can help prevent them.

#12. If something isn’t right, speak up immediately. Remember that it’s your body and you know yourself the best. Get help if you develop new or worsening symptoms. Empower the person you’re with to speak up for you if you can’t.

All of these tips may sound like a lot of work, and you may be wondering why it’s your job to do all of this. After all, aren’t you the patient, the person who is feeling unwell and seeking help? By and large, doctors and nurses are well-meaning, and most of the time, the system is working well and you will get good care. However, mistakes do happen—and you and your advocate can help prevent medical error. Follow the tips above to make sure that you are safe and well during every hospital stay.

My Mother's End-of-Life Discussion That Changed How She Died

I am a physician. The hardest thing I’ve ever had to do was to end my mother’s life.

My mother was diagnosed with breast cancer at the age of 47. After a seven-year battle that involved multiple surgeries and countless rounds of chemotherapy, she decided that she had fought long enough. She didn’t want to suffer any more. Initially, I didn’t agree with her decision: she was still young; her doctors were hopeful; and there were still some therapies that she hadn’t tried. Over the course of many painful discussions, I became convinced that she had thought through everything. It was her choice to die peacefully and at home. She signed paperwork to this effect and entered home hospice care.

Unfortunately, as with many patients’ wishes, hers did not get fulfilled. One day, her breathing became labored. My father panicked and brought her to the local hospital. By the time I arrived, her blood pressure was dangerously low and she was barely breathing on her own. The ICU doctors were hovering, ready to put her on a breathing machine.

I could have never imagined how hard it was to ask everyone to stop their efforts and let my mother die. There was paperwork clearly documenting her wishes, yet the doctors and nurses asked me multiple times whether I wanted to change my mind. My father and my sister both knew her wishes too, yet they, too, were paralyzed by the thought of letting her go.

Since my mother’s death, I have been on the other side of these discussions as the emergency physician talking to patients and their families. I have learned that less than 30% of families have these discussions, and as a result, many patients end up with life-prolonging measures that are very likely to be against their wishes. As hard as it may seem to have such end-of-life talks in advance, it is many times harder when the patient is in extremis and the family is distraught.

Last week was the two-year anniversary of my mother’s death. In her memory, I urge you to have a discussion with your family members now about how they want to live, and to die. Make sure your doctor knows, and that you have paperwork documenting these wishes. That way, you will be able to honor your loved one’s final wish, and you will know what to do when you are faced with the most difficulty decision of your life.