A layman's guide to getting the best during a hospital stay

There is a lot you can do to improve the quality of your hospital stay.

While hospitals can provide a secure refuge when you are seriously ill, remember that hospitals can be scary places! For one thing, the very fact that your doctor wants you to be admitted into hospital means that he thinks you are quite ill and this in itself can generate considerable anxiety! Even worse, hospitals can be very unfriendly places. Not only do hospitals strip you of all your dignity (having to wear a half-open hospital gown which barely covers your body properly does not do much good to your ego!), but also they subject you to painful routines and humiliating rituals performed by a retinue of strangers. Moreover, you could be woken up at any time of the day, (or night), deprived of your privacy, forced to eat unpalatable food, cut off from friends and family, and denied a lot of the independence which you take so much for granted in daily life. Also, remember that hospitals can be dangerous to your health as well! Hospital-acquired infections have become increasingly common (since a number of sick patients are gathered together under one roof); and errors and mix-ups are not unusual at all, especially in India, where the paramedical staff is often poorly trained.

The first rule, therefore, is try to stay out of hospital as far as possible! However, if there is no choice, there is a lot you can do to improve the quality of your hospital stay.

The first step is selecting a hospital. Often, you may have no choice in this regard. For example, your surgeon may operate at only a particular institution. Or your employer may have entered into a contract with a particular hospital, so that if you want your hospital expenses to be covered by your company, you may have to be admitted only to this hospital. However, if a choice is available, then how do you select the best hospital?

Basically, hospitals fall under the following categories:

1. Private large hospitals. These are large (200-bed plus) institutes which offer all medical facilities (including pathology, radiology and blood banking) under one roof. While such hospitals often attract the best medical specialists, and many have a developed a reputation for providing excellent medical care, they can be very expensive . Unfortunately, they are also usually very impersonal, and you are often just "the patient in bed number 423". Also, the red tape in these places can be considerable. These hospitals tend to overuse medical technology, which can prove to be a major disadvantage while treating common problems. However, these hospitals should be your first choice if you are suffering from a complex or rare problem, or if you require major surgery.
2. Private small hospitals/nursing home. These are small facilities (containing 10-20 beds) which are usually run by a single doctor, or a small team of doctors, in order to provide care for their own patients. They are very popular, because they are relatively less expensive and provide patients with personalized care and attention. However, many of these places are poorly equipped (for example, a doctor may set up a cardiac monitor at the patient's bedside, and call the bed an intensive cardiac care unit!) Also, the staff may also be poorly trained. Such places may not posses the infrastructure (e.g. blood bank facilities) to cope with complex problems. On the whole, well-run nursing homes are a good choice for treating simple problems (e.g., simple surgical procedures such as appendectomy or hernia repair).
3. Public (teaching) hospitals. These are large hospitals run by the government. While they may posses excellent medical staff, since they are often attached to medical colleges, their equipment, however sophisticated, often does not function, due to a paucity of funds. Often, basic standards of hygiene may be lacking in these places. Nevertheless, they can provide excellent medical care at highly subsidized rates and are a good choice for emergencies (since they are well-equipped to handle trauma and emergency cases, and will not turn patients away) and for certain complex problems, since some of the departments in these hospitals can be centers of excellence.

Choosing your room

During a stay in the hospital, several options are available as to room choice. Depending on insurance coverage or personal preference, a patient may stay in a private room, a semi-private room or a ward. Private rooms may be deluxe (with amenities comparable to a five-star hotel in some hospitals) or first class, and offer the advantage of much needed peace and quiet. A major plus point is that your friends or relatives can stay with you; after all, you need to have someone who can look after your best interest when you in a hospital bed! In a semi-private room, curtains are put up around each bed that allow for some privacy, but the bathroom is usually common for the occupants. A ward is a hospital room that is large enough to accommodate several beds. Each bed may be curtained off during examination for privacy, but you are otherwise fully exposed to all passersby. However, the charges are much less than those of a private room. (Read: Patients rights in India What you should know and ask for)

Looking after yourself

Nobody likes to be in the hospital --- and it's especially difficult if you have to be hospitalized for a long time. Some ideas which can help you to keep yourself from becoming bored, depressed or lonely if you have a long hospital stay include the following: keep a journal; write letters to family and friends; do activities such as needle point, sewing, knitting; listen to a radio; talk with other patients; read a book; do puzzles and word games; play computer games; and surf the Internet on a laptop.

Hospitals can be dehumanizing places to be in, so try to personalize your surroundings as far as possible, by surrounding yourself with objects you enjoy, such as books, a radio, games and puzzles. Try to arrange for food from home, if at all possible --- hospital food has a deservedly bad reputation. It's also a good idea for you to have your mobile/cellphone with you, in case an unforeseen emergency crops up during your hospital stay.

It's useful to ask for help from family and friends. Request them to come and visit you. Most people will be glad to oblige. But remember to return the favour if someone you know is in hospital. If you like, you can ask them to bring food or fresh fruit that is not served in the hospital, so that you can look forward to eating something appetizing. And don't forget to look at the upside -- you get served breakfast in bed!

Medical Records: To see or not to see?

Although your medical chart affixed to your bed is legally the property of the hospital, you should be aware of what kind of information is recorded on it. If you have any doubts, ask your doctor for an explanation. The chart should contain the following details:

• Your medical history (in the form of a synopsis).
• Results of all laboratory tests.
• Doctor's order sheet: (1) daily list of medications to be taken, (2) special treatments or testing, (3) dietary restrictions, and (4) scheduled diagnostic procedures.
• Notes on surgery performed: (1) name of operation; (2) anesthetic used; (3) the names of the assisting staff; and (4) whether or not blood was transfused.

Don't be surprised if you encounter resistance when you ask to see these records ! Many physicians and hospitals still don't believe that these records belong to you, or even that you should have access to them. As with any argument, there are two sides of this one too. The most commonly voiced concern is that patients may misinterpret the records, and become confused or unnecessarily frightened by the information they contain. Further, physicians and hospitals are concerned about their malpractice liability being increased if patients are granted unlimited access to their records,' and some fear that records will not be kept with the same degree of honesty if patients were to have direct and unlimited access to them. Patients, on the other hand, want to know what is in their records --- after all, the records are about their body! They also believe quite correctly that they can store their x-rays and records more reliably than anyone else. The ideal situation is one where you and your physician go over the records together, with your physician explaining the information, and you knowing that you can ask any question and get a clear and honest answer.

The Hospital Routine

An average day in a hospital can be divided into five categories. They normally involve the following:

1. The patient's activities such as lab tests (often done early in the morning), treatments or scheduled surgeries, visiting hours and rest periods.
2. Nursing observations which include monitoring and charting your vital signs (pulse, blood pressure, temperature, urine output) on a frequent basis; as well as evaluating your physical and emotional needs. A good nurse is worth her weight in gold!
3. Doctor's visits such as the morning observations of patients by your doctor, his assistant or residents. Doctor's rounds may occur at various times during the day.
4. Medications which can begin before breakfast and continue throughout the day and night as prescribed by the doctor. Intravenous lines (V fluids) require more frequent nursing attention.
5. Meals which are normally brought by orderlies three times daily. A night-time drink or snack may also be available.

Who's who at the hospital

In a hospitals one finds so many people walking around in white uniforms that patients to become easily confused as to who does what! While it's the normal procedure for all the staff to wear name tags that identify who they are and what their positions are, a understanding who does what in a hospital is beneficial.

Physicians

1. Medical Students: They are found only in teaching hospitals (attached to a medical college), and are trying to learn as much as possible. They cannot actually treat patients by themselves, but a kind and understanding student can often spend a lot of time with you and explain what's going on.
2. Residents : They are doctors who are receiving specialty training in a particular medical field such as surgery or medicine.
3. Doctor: The doctor who admitted you to the hospital.
4. Consultants: They are specialists, and your doctor may ask them to examine you to provide expert advise or a second opinion.

Nurses

Nurses are the ones who really take care of you when you are in hospital, and their responsibilities include: (1) taking and charting your vital signs (such as temperature, pulse and blood pressure); (2) taking care of your wound; (3) carrying out your doctor's orders; (4) giving you your Nurses spend much more time with patients than doctors do, and will often be your primary contact with your medical caregivers. They can also teach you to care for yourself when you go home.

Additional Hospital Staff

1. Orderlies or nurse's aides assist in moving patients to the x-ray room or to other specialized testing rooms and help in a non-medical capacity.
2. Occupational Therapist assist disabled patients in performing their routine activities.
3. Physical Therapists assist patients in developing the strength and the ability to become and remain mobile through exercises, massage, and other treatments.
4. Respiratory Therapists help with the use of specialized equipment to treat breathing disorders.

It is very helpful to know someone on the hospital medical staff (an 'insider') with whom you can really communicate. This individual may be a nurse, a technician or a social worker. Request this person to act as your advocate in order to help you get the medical care you need and want --- a medical 'insider' who is on your side can be very useful when you are in hospital! (Read:

How to be a cost-conscious hospital patient

Hospital bills can add up to huge amounts very easily, and you need to be aware of what step, you can do to save your money! The basic rule is simple: avoid an unnecessary stay in the hospital! The hospital should never be viewed as a place to get a good rest. Consider the following pointers:

• Consult your physician and, whenever possible, select outpatient services. By avoiding an overnight stay at a hospital, substantial savings can occur. Many routine laboratory tests and scans can be done for a lesser cost as an outpatient.
• As an inpatient, stay only for the prescribed time that is necessary. If it's peace and quite you need in order to recuperate, a hotel may be a better bargain.
• If you need surgery, ask your doctor if this can be done on a day-care basis, so that you don't need hospitalization.

How to keep your hospital bills down

• Be an intelligent and informed patient --- ask questions, to make sure that all the medical procedures you have been advised are truly necessary.
• Take out a medical insurance policy when you are healthy. This policy can be very helpful in case you do fall ill.
• Hospital bills can be huge, and they need to be carefully analysed to look for errors. Don't assume that just because a bill is generated on a computer that it's accurate --- billing errors are amazingly common, and you need to actively look out for them. Insist on a receipt whenever you pay your hospital bills.
• Beware of duplication of tests. Be sure to ask the doctor the kind and frequency of blood tests, x-rays and medical procedures you shall have to undergo.
• check-out times should be strictly followed. Be sure you know when precisely you must leave and stick to your schedule; otherwise, you're likely to be charged for an extra day's stay.
• If your health problem isn't an emergency, avoid being admitted to a hospital on a weekend. No one likes working on weekends, and testing will usually not take place until the following Monday.
• Discuss your financial concerns with your doctor. Many doctors and hospitals can and do reduce their fees for patients who have problems with payments. Also, remember that you will get exactly the same quality of medical care in a first class deluxe room in a private hospital, as you will in the general ward --- but you will end up paying about ten times more!

Remember that sooner or later, you or a family member will have to spend some time in a hospital. If you are well - prepared, you can make sure you will survive your stay in style --- so that you can show off your surgical scar to all your friends at the next party! (Read: Patient advocacy why patients need to be given a voice)

The following checklists can help you to retain control over your hospital care.

Hospital checklist

Reason for admission (Diagnosis) ___________________

What procedures, tests or treatments cannot be done as an outpatient?
________________________________________________

What tests could be done prior to admission to shorten hospital stay?
______________________________________________

Expected length of stay (days) _____________________

choice of hospitals:

Hospital Average Daily Cost

______________ Rs _______

________________ Rs _______

________________ Rs _______

Can admission be arranged early in the morning ( rather than the previous night, thus helping to reduce your bill)? ____________________________________

Are consultations planned? _____________________

If yes, why, and who will perform them? ____________

Can the consultants be seen prior to admission?
____________________________________________

If diagnosis or treatment is unclear, has specialty consultation been considered? _________________

If not, why not?_______________________________

COMMENTS

_____________________________________

Daily Hospital checklist

Reason for continued hospitalization? What procedures, tests, or treatments cannot be done as an outpatient?

Tests ordered today: __________________________________

Tests needed before discharge: ________________________

Medications:

Medications ordered today? How often? Why?

_______________________ ___________ _____________

_______________________ ___________ _____________

Can any medications be stopped? (Go over list) ___________

Can I eat (or eat more)? _______________________________

Can IV be removed? _________________________________

Can I walk around? __________________________________

What extra hospital equipment is presently in use?

Can any procedures the use of any or equipment be discontinued? ______________________________________

How many physicians continue to be involved with care? ____________________________________________

Who? ________________ ________________ ___________

Why? ________________ ________________ ___________

Discharge plans When? _______ Where? _______________ Will additional nursing care be needed at home ? Has this been arranged? ___________________________ Has transportation home been arranged? ______________ When do I see the doctor after being discharged ? Where ? Whom do I contact if I have a medical problem ? Whom do I contact if I have a problem with the hospital bill ?

What has been your experience with doctors and other medical practitioners in India? Do you think awareness can improve the situation? Write to us at health@corp.india.com. We want to hear from you!

Dr Aniruddha Malpani is an IVF specialist who passed out from Bombay University, winning over 20 gold medals during his academic career. His clinic at www.drmalpani.com attracts patients from all over the world. He also runs the world's largest free patient education library, HELP , at www.healthlibrary.com. He has authored 4 books How to Get the Best Medical Care (www.thebestmedicalcare.com),Successful Medical Practise, How to Have a Baby and Using Information Therapy to Put Patients First. His passion is patient empowerment, and he believes that patients are the largest untapped healthcare resources, and we need to use patient power to heal our sick healthcare system. He has pioneered the use of innovative technology to educate infertile couples, using cartoon films, comic books and e-learning on his website- www.ivfindia.com. He is an angel investor in Plus91 ( www.plus91.in) , a company which provides websites for doctors, and PEAS ( www.peasonline.com) , India's market leader for creating digital media for patient education, and is on the Board of Inventurus Knowledge Solutions, a healthcare BPO which provides RCM solutions for the US market. He can be contacted at http://www.ivfindia.com

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