What to Do When Entering the Hospital

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Hospitals can feel like an alien world with unfamiliar sights and confusing customs

As I walk the halls of my hospital, I pass many who wear the confused look of travelers in a strange land. They’re like refugees or tourists on a terrible trip, shuffling papers as they walk along sterile corridors, reading each sign as they pass. They’re lost, overwhelmed, and scared. They don’t know where things are or how they work. I try to make eye contact. I smile and send up silent prayers for comfort. I point and say, “Turn left, then left again, then right, and you’ll see the elevators.” If I have time, I walk them to their destination. I understand. I’ve been on that same awful journey.

These shipwrecked souls have recently seen a family member’s health passport get stamped “Disease A” and have been directed into the bowels of the hospital for admission. They are ill-prepared to navigate this unfamiliar world, and their minds are racing with a thousand questions: What now? Who should we call? What did that nurse say? Who will be the doctor? When will I see my loved one? How are we going to pay for this? Where is the elevator?

The patient fares worse. As they are shunted from one strange place to another, watching ceiling tiles fly by and nurses talk about their day, they too have questions: When will I see my family again? Was that a doctor or a nurse? When can I get something for my pain? Have these nurses forgotten that I can hear them?

A New Kind of Doctor

If you haven’t been hospitalized recently or haven’t had reason to visit someone in the hospital, you might not know that your primary care physician will not be seeing you once you cross the hospital threshold. In the hospital world, there are hospitalists.

I have worked as an internal medicine doctor in hospital-based settings for much of my career. I was recruited during my residency in 1992 to help pilot a new way of delivering medical care to hospitalized patients. This was staffing hospitals with full-time physicians.

This plan proved to be a success. Suddenly doctors were available around the clock to see patients. The length of patient stays in hospital ICUs dropped. Medicine’s knowledge base regarding hospital care grew exponentially. In 1996, the term “hospitalist” was coined. This new breed of doctors allowed primary care physicians to see more patients in their practices.

It seemed to be a win-win—unless you were used to your family doctor visiting you in the hospital before and after their office hours. In that case, the new arrangement proved to be confusing, frustrating, and scary. Each uneasy patient would wonder if doctors like me, whom they had never met before, were capable and qualified.

Of course, for the hospitalist model to work most effectively, health care providers, both in and out of the hospital setting, must communicate effectively. Electronic medical records (EMR) has improved this significantly, but there are still times when systems don’t “talk properly to each other.” Just because records can now be sent instantly doesn’t mean they actually do get sent instantly. Thus, I always encourage patients, particularly those with chronic illness, to keep a recent copy of their primary care physician’s notes and a current list of medications.

In the event of hospitalization, primary care physicians are now able to provide a patient’s EMR, including ongoing lists of medical diagnoses, surgical histories, medications lists, personal notes, and more.

This information gives a hospitalist information they need at a time when patients and families are inclined to forget important details. This sharing of information is equally important when the hospitalist hands the care of the patient back to his or her primary care physician. Patients should always request that a copy of their medical discharge summary be sent to their primary care physician and request a copy of their medical records for their files.

Entering Hospital Land

When going to the hospital, it’s helpful to bring medical bottles with medicine and dosing on them. This is for two reasons.

The first is because it gives the most accurate picture of what you are taking versus what the record may state.

The second reason is that some emergency department times can last several hours.

To ensure you are taking medications on time, notify the nurse of what times you are meant to take your medicine. In a busy emergency department, the nurse might not make it back to your room precisely when you should take your medications, and therefore, either you or your advocating visitor will need to notify the nurse. It’s important to not take any medication without alerting the nurse.

That’s because it’s possible your presenting symptoms are related to one of your medications and therefore would be changed. Always ask someone once you enter a health care facility. The nurse will first check for any drug interactions, and then note in the record that the medicine has been taken to prevent a second dose from being administered later.

If an emergency room doctor determines that you need to be admitted, they will then call the admitting physician. This may be a hospitalist, a surgeon, or other specialty physicians. Often, these medical services use mid-level clinicians. Examples would be a nurse practitioner or a physician’s assistant.

Be prepared to have to tell your medical history and presenting symptoms multiple times in most settings. When you do speak to your admitting physician, be prepared with a list of questions and take note of the answers. This will help make your medical stay more tolerable.

Clarity is kindness, and understanding the process of your hospital care will help overcome unnecessary anxiety and stress for you and your family members.

Requiring hospital care can provoke emotions of fear, anxiety, depression, and stress. Patients and family members can avert or lessen these emotions by coming prepared with the right expectations, right questions, and right self-care.

Questions for New Patients

It’s important you be proactive about getting the information you need to make good decisions about your medical treatment. The hospital experience can be disorienting, so the following list can help you get what you need. Ask your doctor:

  • Will you please give me in writing the name of my diagnosis?
  • Am I the normal age and gender for this diagnosis?
  • Are there any genetic tendencies for this disease and, if so, do I need to have my children tested?
  • Can you give me descriptions of each treatment path and the associated risk/benefit ratio?
  • Are there any places in the country that specialize in this disease and treatment?
  • Do you have a holistic approach to treating this disease?
  • What can I do to help my outcome?
  • What is my prognosis?
  • I would like to seek a second opinion. Is this OK with you? (I encourage posing this as a question because the correct answer is always, “Absolutely!” If the doctor becomes defensive, he or she isn’t the best doctor for you, perhaps not even for your first opinion.)
  • If this were your spouse, child, etc., what would you do? (The importance of this question can’t be stressed enough. It will not only give you valuable information, but it will also develop empathy as he or she ponders the reality of the recommendation they are making.)

Questions for Patient Advocates

  • If your loved one is entering the hospital, they will appreciate having someone there to help them navigate the sanitized terrain. If that person is you, this list of questions can help you help them. Ask your loved one’s doctor: Will you be the only doctor on my loved one’s case, or will there be others?
  • What time do you make rounds and what time would be best to receive an update on our family member?
  • If visiting hours don’t happen to coincide with the time you are making rounds, how can we get a few minutes with you to discuss our loved one’s situation?
  • If there are any significant changes, will you give us a prompt update? Does your nurse have our cellphone numbers?
  • If we have questions between visiting hours or rounds, what number can we call to speak to you or your nurse?
  • Are there any questions that we haven’t asked that we should ask?

Navigating a Hospital Stay

While hospitalized, patients or their advocates can help promote a safe outcome. These guidelines will help ensure your stay in the hospital, and what comes next, can best support your healing and ongoing health.

  • Keep moving as physically able. Small walks, moving from bed to chair, and even calf pumps (flexing and extending the ankles) promote muscle movement and reduce the risk of blood clots and debility.
  • If you are given an opportunity for post-hospitalization rehabilitation, take it. Being inactive leads to a rapid loss of muscle mass. Rehabilitation is especially essential for those who are frail because they are prone to falls at home without adequate strength training.
  • Watch for infections: Wash your hands and have visitors do the same. Most hospitals have hand sanitizers readily available. Observe IV lines for signs of redness, and keep an eye on wounds and surgical dressings. Your nurse and doctor should be doing this; however, the patient and advocate can participate for best safety outcomes.
  • Ask to discuss an advanced care plan if you don’t already have one.
  • At the time of discharge, make sure you understand all discharge instructions. Ask your hospital-based doctor if they would call your outpatient physician for transitions of care.

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