Most people are surprised to learn that more accidental injuries and deaths occur while receiving healthcare than from all other kinds of accidents added together. It can be quite daunting to navigate the healthcare industry. So what should you know when you have to get surgery?
Below are some tips from Michael J. Saks & Stephan Landsman, authors of the new book Closing Death’s Door (Oxford University Press 2021).
Before going into the hospital:
1. Get a second opinion. Avoid, if possible, being rushed into invasive procedures that could wait for a second opinion. Neil Armstrong, the first human to set foot on the Moon, likely died from being rushed into a coronary bypass procedure that was not handled well, and which
could have been more carefully considered with a second opinion, and a more thoughtful choice of surgeon and hospital.
2. Check on the safety record of the hospital you will be treated in by consulting online ratings. Centers for Medicare and Medicaid Services or The Leapfrog Group are some of the most reputable sites for ratings. Make sure the hospital is accredited by The Joint Commission (qualitycheck.org). Some states post their own hospital ratings; if available, check those, too. (But be cautious about ratings by patients of their doctors. Research has found little correlation between patients’ ratings of doctors and serious problems those doctors have gotten into. Bedside manner carries too much weight with too many of us.)
3. Make sure the procedure your surgeon is going to perform is one that she or he has done many, many times before and continues to perform frequently. Research has found that, for most procedures, the best outcomes and fewest complications arise when the surgeon performing the procedure has considerable experience with the procedure and maintains a schedule of frequently performing it. Some hospitals have even “taken the volume pledge,” that is, they allow only surgeons who perform a certain minimum number of high-risk surgical procedures to continue performing those procedures.
In the hospital:
4. When you are going to be in the hospital, try to have a close friend or family member be with you as much as possible – as your advocate, your eyes and ears, your brain, to watch what is happening, to ask questions, to take notes. Obviously, you, the patient, might not be at your sharpest when you are needing medical care. You and your advocate should pay close attention to changes in your condition (pain, fever, thirst, dizziness, etc.) and ask about them. Be alert to the danger of falls, which can happen so easily and cause serious harm. Don’t be shy. Don’t suffer in silence. Moreover, good healthcare organizations encourage patients (and family or friends) to ask questions and to speak up if they see something that concerns them.
5. You can avoid medication errors by asking hospital staff what you’re taking, how much, how often and why. Armed with that information, you have a chance of catching discrepancies when someone from your medical team comes in to administer drugs, and to make sure that the right drug and right dose are delivered to the right patient.
6. On any given day, about 1 in every 25 hospital patients contracts an infection. The single easiest and most effective solution is to remind your clinician to wash his or her hands. It is also one of the most frequently skipped infection-prevention measures.
7. During your pre-op preparation, ask what procedure is to be performed on you – if someone from the care team has not already asked you. And make sure the correct arm, breast, brain hemisphere is clearly marked.
After you leave the hospital:
8. Be sure to follow instructions for after-hospital care. Nurses usually give detailed packets to patients as the time of discharge approaches, that you have or have arranged for any medications you will need, and that you have contact information for whom to get in touch with if complications arise. Particularly at home, patients should have a list of names and numbers available for immediate use in case of emergencies.
9. Lack of continuity of care can be a serious problem during the transition from the hospital to the next place of care. Problems can arise when care is handed off to a skilled nursing or rehabilitation facility, or anywhere. If your discharge is to your home, it is best to have someone who lives with you or can visit with you frequently (a visiting nurse, perhaps) who understands the post-discharge care instructions and has the skill to carry them out.
10. Opioids can be a very valuable pharmaceutical intervention. But they pose a serious risk of addiction and should be used only as prescribed and when necessary.