Thousands of Americans die each year because of hospital errors. Don't let yourself be a statistic.
By Sid Kirchheimer
Reviewed By Brunilda Nazario
There seems to be good reason for that common but little publicized condition known as "nosocomephobia" -- the fear of hospitals. And it goes beyond those oh-too-revealing patient-issued gowns.
Consider a new study indicating that an average of 195,000 people die each year in American hospitals due to potentially preventable medical errors. This alarming statistic comes after researchers reviewed records of 37 million hospitalizations. In fact, the report, by Health Grades, Inc., which assesses hospital safety, finds that one in four Medicare patients who experienced a hospital error died as a result of it.
"It's perfectly understandable why many people feel the way they do about a hospital stay," says Marc Siegel, MD, internist at New York University Medical Center and clinical associate professor at its school of medicine. "You have control of your life ... up until you're admitted to a hospital."
Then, your fate is placed in the hands of others -- often, overworked doctors, nurses, and other staff who may have the best of intentions ... along with dozens of other patients to care for on each and every shift.
What Can (and Does) Go Wrong
That may explain why medication errors occur in nearly one in five doses administered at the typical hospital or skilled-nursing facility, according to a September 2002 study in Archives of Internal Medicine. That research indicated that in nearly half those errors, the dosage was given at the wrong time; in 30% of cases the drugs weren't given; and in 17% of cases, the issued dosage was wrong. About one in 25 patients got the wrong drugs altogether, say researchers.
Of course, there are other potential problems: Designated menus that contain food that is prohibited for your condition, such as a vegetable-rich diet for patients being treated for blood clots or solid foods served to those needing liquid diets, unresponsive staff to change IV bags before they're empty, and even the biggie -- the risk of having the wrong surgery.
"Many patients go into a hospital on blind faith, because they think that whatever is being done to them is OK because it's a hospital," says Vincent Marchello, MD, medical director of Metropolitan Jewish Geriatric Center in New York City, and assistant clinical professor of medicine at Albert Einstein College of Medicine. "They shouldn't."
So how can you protect yourself during a hospital stay?
"I'd say the single biggest mistake that patients make is to not ask questions about their care," says Marchello. "They don't want to be a bother, but doctors today have a better bedside manner than in the past largely because of efforts made by medical schools. If you think there may be a problem, ask about it ... before it is a problem."
What to Pack
But even before you arrive, you should pack certain items to minimize the risk of trouble. Among the most useful items:
- Your medical history. Before an emergency or planned procedure, have your complete medical history on hand. "I recommend writing it down yourself, and always have it on hand in case you go to the hospital," says Mary Lorrie Davis, LVN, author of the book, How to Survive a Stay in the Hospital Without Getting Killed. "You could get your medical history at your doctor's office, but how many people only go to one doctor for all their health needs. What you tell your ob-gyn may not be the same thing you tell your general practitioner or allergist."
She recommends that your history includes all medications you take -- vitamins as well as prescriptions -- as well as family history of diseases and other important information. "Don't forget about reactions you had to foods or drugs," she tells WebMD. "If you developed a rash 10 years ago after taking aspirin, the hospital needs to know that."
- A pad and paper. Questions about your care will inevitably occur, often when the staff is not around. "So write them down, and review them with your doctor," Marchello tells WebMD. Also keep tabs about the medicine you're getting each day -- its name, color, shape, and dosage. If there's a sudden change, ask why before you take it.
- Some political skills. "One of the smartest things you can do is make an alliance with your nurses," says Siegel. "I don't want to give the message that you have to be nice to be treated nicely, but when you treat the staff with respect and courtesy, you're more likely to be treated with an ultra level of respect and courtesy. By virtue of their illness, it's expected that patients will be irritable. But those who, despite their illness, manage to remain cheerful often get an extra level of response."
Once You're Admitted
Most patients get a stack of papers when they're admitted (emergency patients may get them later). "Read them," advises Marchello, "because one is the patient's bill of rights, which provides answers to a lot of questions. Unfortunately, only about 1% of patients ever do."
Those papers may also include a proxy form, in which you designate a representative to make medical decisions for you in the event you are unable to do it for yourself. A proxy should be appointed even if you're being treated for minor procedures, he says.
Other self-defense strategies to better ensure a trouble-free stay:
- Identify the "point" provider. You may be treated by a slew of personnel, but it's the "primary attending physician" who has ultimate authority over your care. Ask who this is (and it may change during your stay), but this is the person with whom you should address the key issues about your care.
- Show your popularity. There's a psychological edge in being one of those patients who always has visitors, says Marchello. "If a nurse is caring for 10 or 15 patients, and one always has relatives around, psychologically, they tend to be more attentive to them."
However, it's not wise for your visitors to be your mouthpiece if you're lucid. "Family advocates can be very helpful if they work within context of system. Their raising the roof doesn't necessarily bring you what you want, unless the patient is too weak," Siegel tells WebMD. "For instance, family members may want the results of a biopsy report before the patient, to 'spare them bad news.' But we can't do that; it's illegal to not first inform the patient."
- Consider the calendar. If you're having an elective procedure, summer may be a good time to head to the hospital. Medical students traditionally start their internships in July "so you may get more attention," says Marchello. "But it may be also more hectic when they first arrive."
- Notify staff before you need them. When you notice you IV bag has about 2 inches left, call the nurse. "If it gets too low, the blood will clot and you may wind up with an infection or the IV may have to be started again," Davis tells WebMD. "Never wait until the last minute because you never know how long it may take the nurse to come." This is especially true as shift changes occur, typically between 7 a.m. and 8 a.m., 3 p.m. and 4 p.m., or 11 p.m. and midnight. Hospitals with 12-hour shifts (more common these days) usually change between 7 a.m. and 8 a.m., and 7 p.m. and 8 p.m.
- Make sure you're identified. The reason patients have those wristbands? To make sure they are getting the correct treatment. "It's a red flag if a nurse comes in with medication and never asks your name or checks your wristband," says Davis. "If this occurs, make sure she knows who you are."
The bottom line: The best way to survive the hospital is to practice good survival skills. "Never take anything for granted," says Davis.
Published Aug. 16, 2004.
SOURCES: Health Grades Inc. "Patient Safety in American Hospitals," July 27, 2004. Barker K, Archives of Internal Medicine, Sept. 9, 2002; vol 162: pp 1897-1903. Marc Siegel, MD, internist, New York University Medical Center; clinical associate professor of medicine, New York University School of Medicine, New York City. Vincent Marchello, MD, medical director, Metropolitan Jewish Geriatric Center; and assistant clinical professor of medicine at Albert Einstein College of Medicine, New York City. Mary Lorrie Davis, LVN, author, How to Survive a Stay in the Hospital Without Getting Killed.
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