Status Updates From The Empowered Patient: How ...

"Especially with a long, complicated illness, you're going to have lots of doctors traipsing in and out of your hospital room. ...pick [your] favorite doctor and instruct everyone else to talk to her [so she] could then screen what each doctor said and tell [you] exactly what [you] need to know in terms [you] can understand."

"...you can find a medical billing advocate to help you. To find one, visit the website of Medical Billing Advocates of America. The Fairness Foundation, the National Foundation for Credit Counseling, and the Patient Advocate Foundation also offer help to those in debt."

"People think they have to pay the amount on the bill. But doctors and hospitals are very willing to negotiate. For more tips on negotiating, read the book 'My Healthcare Is Killing Me'; there's a free version online (www.myhealthcareiskillingme.com)."

"...ask for an itemized copy of your bill to check for accuracy."

"A 2008 report from the Commonwealth Fund found that more than 1 in 4 Americans is paying off medical debt. Nearly one-third of those with medical debt were unable to pay for food, rent, or heat, and some even took out a mortgage or a loan against their home in order to pay this debt."

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3. Office of the Inspector General (www.oig.hhs.gov): Part of the federal Department of Health and Human Services [and] keeps a list of doctors who have been kicked out of the federal Medicaid or Medicare program because they've been convicted of fraud or patient abuse or have defaulted on their loans.

Websites for Checking Out Your Doctor:
1. Federation of State Medical Boards (www.fsmb.org): Go here to find out if there have been any disciplinary actions against a doctor.
2. American Board of Medical Specialists (www.abms.org): [In addition to a license to practice medicine,] some [doctors] receive board certification in their particular specialty (pediatrics, obstetrics and gynecology, internal medicine, etc.).

"You want to personally see hospital staff members wash or sanitize their hands every time they touch you."

"Central venous catheters (or central lines) are inserted into a large vein leading to the heart and used to deliver medications, fluid, or blood. ...about 250,000 people get central line-associated bloodstream infections each year, and an estimated 30,000 to 62,000 infected patients die. If the hospital wants to give you a central line, ask if it's necessary, and, if it is, ask how quickly it can be removed."

"A catheter can become a breeding ground for bacteria. If you or a loved one has a urinary catheter in the hospital, ask if [it] is truly necessary. If the patient is awake and oriented and alert and can use a bedpan, it may not be needed. If [it is necessary], make sure it comes out ASAP, since the longer it's in, the riskier it becomes."

"On the day of the procedure, if your doctor has ordered IV antibiotics to be administered just before surgery, make sure you get your presurgical antibiotics, as they're sometimes forgotten."

"When you're being prepared for surgery, if the surgical site needs to be shaved, ask to be clippered, not shaved with a razor, as razors can create nicks where bacteria thrive."

"Studies show that staying warm before and during surgery can help you fight infection. ...ask the hospital staff to give you plenty of blankets while you wait for surgery, and ask how you'll be kept warm during surgery."

"...the week before your procedure, ask your surgeon whether you should wash your skin daily with a disinfectant such as chlorhexidine in preparation. Also, ask whether you should have a nasal or skin swab for MRSA, the superbug that causes many hospital infections. If you have MRSA, you can be treated with antibiotics."

"[To ensure that you and your family don't receive the wrong surgery,] say 'My name is _, my date of birth is _, and I'm here for a _' to every doctor, nurse, and technician who comes to take care of you. Also, ask hospital staff to check your ID bracelet before they do anything to you, whether it's giving you a drug or sending you for a CT scan."

"[While staying at a hospital,] you should ask your doctor or nurse every day for a schedule of the medications you're supposed to receive, along with the dosage and what the medicine looks like. ...check off whenever a dose of a medicine is given so that it won't be given again."

"Don't forget the hospital's house phone. If things get really bad and no one is helping you [in the ER], look for a house phone, dial zero, and ask for the hospital administrator on call."

"If you're not getting service [in the ER], make some noise. Speak up. Say, 'I need to see the person in charge.' If the condition of the person you brought in has become worse, say so. Don't get angry, and don't lie."

"Don't use an ambulance unless you really need it. There's a myth out there that if you arrive in an ambulance you'll go straight back to the doctor. It's not true."

"...to avoid long waits in the ER, while you're on your way to the hospital... call your family doctor and ask him to call the ER; ...when [ER doctors] hear from a fellow physician, they listen."

"The Leapfrog Group and HealthGrades have information about what constitutes high volume for various procedures, and they also have information about staffing. [For example,] your risk of dying in an ICU drops 40% if the doctors working there are 'intensivists', which means they have specialty training in critical care."

"Studies show that hospitals that perform a high [volume] of a given procedure usually have the best results."

"If the information you're looking for isn't available on the Internet, you can call the hospital's quality office."

"To find out which hospitals rank highest for certain specialties, you can [check out U.S. News & World Report's top 50 hospitals and] go to www.healthgrades.com or www.leapfroggroup.org. ...some other useful sites for choosing a hospital: the Joint Commission (www.jointcommission.org), which lists hospitals that have certification for various medical specialties"

"Before you have a scheduled procedure, invest time in learning about which hospitals have a good track record for that procedure. Hospital Compare (www.hhs.gov) gives detailed information about procedures performed at different hospitals."

"...a hospital can also kill you if it's not suited to respond to your particular medical situation. ...it's worth doing whatever it takes to get to a hospital that has the right equipment and staff with the best training [for your medical situation]."

"...in 2008 the average total waiting time in a U.S. emergency room was 4 hours and 3 minutes"

"The CDC says health-care workers have a 'poor' record of following very basic hand-washing procedures, with only 40% adhering to recommended guidelines."

"Approximately one out of every 22 patients who checks into a U.S. hospital acquires a bacterial infection"

“According to another IOM report, at least one medication error will happen to you every single day that you spend in the hospital.”