Hospitalization can be a harrowing experience. Patients arrive seriously ill or injured, and in addition to whatever ailments they’re suffering, they must simultaneously find ways to cope with unfamiliar medical professionals and uncomfortable procedures. We doctors and hospital support staff are often asking these people—some of whom might be quite sick or in a great deal of pain—not only to quickly understand their complex conditions and treatments, but also to arrange for the assistance and care they’ll need after discharge. Many will find themselves facing new medications, follow-up treatments, a rash of specialists, unfamiliar equipment, and physical limitations—and this barely takes the emotional strain into account. It’s not difficult to see why such a large number of patients and their families report being overwhelmed by a hospital stay.
As a hospital physician, I see patients and families every day who struggle to understand the information they are (or sometimes aren’t) given. Patient advocacy—for yourself or for someone whose care you’re responsible for—significantly affects health and recovery. I want to help make you better at it.
Hospitals around the country have embraced Atul Gawande’s checklist approach to managing medical care, described in his 2010 book The Checklist Manifesto: How to Get Things Right, and have seen dramatic improvement. According to the World Health Organization, a study in eight hospitals showed that the implementation of checklists during surgical procedures reduced the rate of deaths and surgical complications by more than a third.
It seems likely, then, that patients would benefit from a checklist of their own. The following list is a resource meant to aid patients and their loved ones in better preparing for and understanding what information they’ll need before, during, and after a hospital stay. The 12 steps cover how to obtain vital information for recovery as well as which member of your hospital care team can provide it.
1. After admission, ask the names of your primary hospital doctor and the other specialists who make up your physician team. Your primary hospital physician will coordinate with the team, and your nurses will assist you during your stay.
2. Ask your physician: What is my main diagnosis, and are there any other newly diagnosed issues? Feel free to express your fears and anxieties about your diagnosis to the physicians and nursing staff. Don’t let the anxiety build until it becomes uncontrollable.
3. Ask your nurse or physician: How are my illnesses responding to treatment? Ask the nursing staff in particular about how your condition is progressing and how you can facilitate your recovery. It’s your fundamental right to obtain information regarding your medical condition. Understanding both your diagnosis and your treatment plan is a central tenet of the Patient’s Bill of Rights, which was adopted by the Association of American Physicians and Surgeons in 1995. According to this document, all patients are entitled “to be informed about their medical condition, the risks and benefits of treatment, and appropriate alternatives.”
4. Ask your family, friends, or other trusted individuals to be involved and help support you in your recovery. Yes, it’s hard to put ourselves in a situation where we feel like we’re burdening someone or losing our independence, even for a little while. Understand that these people are an integral part of your treatment team and contribute to the success of your recovery.
5. Ask to speak with a hospital social worker if you have questions about insurance and billing related to your stay. The social worker is there to help clarify what your insurance covers and how much you may be required to pay. If you need assistance with payment, discuss the options available to you with the social worker before you leave as well.
6. Ask to see the nurse manager or charge nurse if you’re experiencing ongoing issues with care or communication about your condition. The person in this role is responsible for helping patients and easing any misunderstanding or tensions that may arise during your stay.
7. As you approach discharge, ask if you should continue taking any of the medications (including vitamins and supplements) you took before you were admitted. This information should be included in your discharge instructions, but take the time to fully understand this aspect of your care to avoid potentially disastrous or even fatal complications later.
8. Ask the staff to show you and your caregivers how to perform any tasks prescribed for after you’ve left the hospital, especially any treatments that may require a special skill, such as changing a bandage or giving an injection. Ask the nurse or physician to remain in your room while you practice to ensure you’re doing it correctly.
9. Ask your nurse or physician if it’s safe to perform ordinary tasks alone, like bathing, dressing, driving, or exercising. Make sure you’ve arranged for help with any of these activities before you leave the hospital.
10. Ask your nurse or physician if you can or should use any medical equipment, such as a walker, brace, or health monitor, to help with your recovery and comfort. If the answer is yes, ask for assistance in obtaining these items before you leave or shortly after your return home.
11. At the time of your discharge, ask the discharge nurse any questions you have about your discharge information. You should have been provided with printed discharge instructions. Don’t leave the hospital without obtaining these, reading them (or having them read to you), and making sure you understanding all of the information they cover.
12. Ask about any follow-up appointments or additional testing. Take a moment now to record anything that’s already been scheduled or to schedule necessary appointments in the coming weeks.
My hope is that regular use of this checklist will aid physicians in providing more streamlined and accessible care; will further educate patients in how to advocate for themselves; will help facilitate the best possible hospital experience for patients; and will reduce or eliminate some of the strain on the emotions, wallets, time, and energy of everyone involved. If we can ease the many demands of a hospital stay, we’re working in service a medical team’s goal: a successful patient recovery.