Be Safe in the Hospital: Learn How

By: Dr. Bill Honigman, MD recently retired Emergency Medicine Physician in partnership with the Patient Safety Movement Foundation

Visiting the doctor or going to the hospital can be frightening. Whether it’s fear of bad news or a bad experience many people dread visits to the doctor. Worst still, according to a recent study by Johns Hopkins University, is knowing that medical errors are the third leading cause of death in the United States, behind heart disease and cancer.

Is this a surprise? With advances in technology, more and more physicians are rushed and spending on average only 15 minutes with each patient. Due to this rush, studies seem to indicate that doctors aren’t doing a good job of listening to patients. A US News and World Report article reported that patients were able to conclude their “opening statement of concerns” 23% of the time while a non-profit that accredits U.S. healthcare organizations found “inadequate communication” in 70% of adverse health outcomes not related to the patient’s illness.

As an ER doctor, I often saw people who had fallen through the cracks of a system well-intentioned or otherwise, that failed to prevent complications such as healthcare-associated infections, blocked or displaced tubes and catheters, bleeding wounds and blood clots, and other life-threatening conditions.  I served on my hospital’s Utilization Review Committee, where mostly I advocated for allowing enough time before discharge to adequately assure stability, and adequate follow up in the clinic or home setting to assure ongoing evaluation and treatment that might be needed after hospitalization.

So, what can you do to be a better patient and make the most of your next doctor’s visit? Here’s a simple list of things that you can do!

  1. Plan ahead
    1. Begin by writing down a list of any medications you are taking and write another list of any symptoms you are having (your reason for visiting the doctor.) Remember communication goes two ways and a doctor can only help you with the information that they are given. Always assume that the best information about you will come from you.  Medical providers don’t always have complete records but should at least confirm all relevant information in a good history. If your doctor doesn’t seem to know this or seems to not listen to you, then it’s time to get a new doctor.
  2. Bring an Advocate
    1. No one wants or expects to have a serious diagnosis which is why you should always bring someone you trust with you. Your advocate will be able to stay calm and help listen to your critical information on your diagnosis and options.
  3. Ask Questions
    1. A 2010 survey of patients who have recently made a medical decision has found that those patients often did not receive critical information about the risks and benefits of the treatment and intervention choices under consideration. Make sure you aren’t one of the many patients who doesn’t feel informed and ask questions.
    2. Are there alternative treatments? Are there side effects to the antibiotics or the procedure you are prescribing or recommending? Is there anything else you can do to get better? How soon will I begin to feel better? Is there anything I should look out for before I schedule a follow-up?
  4. Repeat it back
    1. Studies show that most people don’t understand the doctor’s instructions. This can be a problem as you’ll only get better if you understand your treatment. It gets worse. One study showed that patients only recalled 40% of the information they were given and almost half of what they thought they remembered was incorrect. [1]The solution is simple. When patients repeat back or “teach back” their medical conditions, treatment options or self-care instructions to the doctor in your own words, it gives the provider a chance to correct and clarify anything you may not understand. Studies from reputable sources including the Columbia Medical Review say that the teach-back has achieved improved comprehension and information retention by patients.[2],[3],[4]
  5. Can You Read the Prescription
    1. Make sure you can read any prescription your doctor prescribes. If you have trouble reading it, the pharmacist may have trouble as well. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings.[5]And the effects of the wrong medication can be serious. You can help prevent an error by making sure your prescription is legible. Then, when you get the prescription filled, make sure it is what the physician prescribed.
  1. Get Discharge Instructions
    1. Patients with clear after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30% less likely to be readmitted or visit the emergency department than patients who lack this information, according to an AHRQ-funded study.
  1. There’s an App for That
    1. If you are tech savvy, you may want to look into free smartphone applications, like PatientAider, which can help you navigate you or your loved ones next hospital visit, including questions you should ask and an easy to understand glossary of common medical terms.

Here’s the good news, studies show that Patients who are more actively involved in their healthcare, experience better health outcomes and incur lower costs. (Health Affairs 2013).

[1] Anderson JL, Dodman S, Kopelman M, Fleming A. Patient information recall in a rheumatology clinic. Rheumatol. Rehabil. 1979;18(1):18-22

[2] Kornburger C, Gibson C, Sadowski S, Maletta K, Klingbeil C. Using “teach-back” to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process. J Pediatr Nurs. 2013 May-Jun;28(3):282-91

[3] Howie-Esquivel J, White M, Carroll M, Brinker E. Teach-Back is an effective strategy for educating older heart failure patients. J Cardiac Failure. 2011;17:1-10

[4] White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? J Cardiovasc Nurs. 2013 Mar-Apr;28(2):137-46

[5] J Community Hosp Intern Med Perspect. 2016; 6(4): 10.3402/jchimp.v6.31758. Published online 2016 Sep 7. doi:  10.3402/jchimp.v6.31758