Saturday, November 19, 2011

How To Get The BEST Medical Care: Insider Tips From A Doc! Part 1: In the Hospital!

If you ever expect to be in the hospital or expect to have a family member in the hospital than I strongly encourage you to read this series of posts & email them to your family & friends.  I'm not writing about food or nutrition or weight loss here but this post IS about HEALTH.  I'm writing this post on hospitals instead of my planned "outpatient tips" because I had a family member in the hospital last week and the whole experience made me realize how confusing the hospital is to everyone but us healthcare providers!!

Before I get to far into this post I want to say two things.

First, if you are one of my doctor/nurse/ancillary staff readers, please feel free to add any other "insider" tips to the comments to be of service to other readers.

Second, when I say, "how to get the BEST medical care" I am NOT saying that we are not trying our best to care for you!!  I am just letting you know a few simple ways to allow your doctors & nurses (and everyone else who cares for you) to perform to the best of their abilities.  At our best we can treat you more effectively & provide you with care beyond our usual high standard.

I planned to make this a single post at first but there is SO much information to share about how to navigate the hospital system that I'm breaking this up in to FIVE posts. As a side note--I don't particularly like the way this all works, but its the system we currently have & I want you to all get the best out of it!

Here are Tips #1 & #2 to get the BEST medical care during a hospital stay: 

Tip #1: Be a teammate:  The only information about your history that we know is what you tell us.  Be an active participant in your care--this is a team effort.  It may not seem that way because since we docs do have definite opinions after spending >12 years in school/training.  But this is your body & you need to take responsibility as well.  

Ask questions (See below on how to organize these questions to get the MOST data).  Understand what is going on and why different tests are being done.  ASK the KEY questions I list in TIP #3 (next time).  The most important thing is to be prepared, organized & concise (see my points below).  Write things down. THIS IS A TEAM EFFORT!!

Tip #2:  Be concise & be organized:  
The key to all hospital communication is "keep it short."   

How can you interact with physicians to get the best care AND get a good understanding of what is going on?:

On admission:  

  • Bring the Meds, Allergies & Past Medical History documents I suggest (in tomorrow's post) & have the doc/staff make a copy.  Say that all the background information they need is on those sheets.
  • If you have time en route to the hospital (& you or your family member is able to do so): jot down a quick timeline of all the events that led to you needing to go to the hospital. 
    • Example:  Monday my stomach started hurting.  It was a stabbing pain in the left side of my belly.  Tuesday I began to vomit dark material.  Wednesday I fell because I was lightheaded and then we came to the hospital

In the hospital:
  • Pick ONE spokesperson for the family.  This person is the point person for the family & will communicate all information to other family members.  Try to have this person be the only one who speaks during conversations with the doc.  The spokesperson can be YOU if you are the patient & want to be the one asking the questions.
  • Put together a master list of all the questions you & your family have for the doctor. **Make sure you ask the KEY questions I list in tomorrow's post if they are relevant to your situation.** 
  • After writing out all you can, prioritize them.  What do you need to know IMMEDIATELY?  What do you need to know eventually?  What do you need to know before the patient leaves? 
  • Then go through the list & edit it again making EACH questions as short as possible.  
  • If there are questions on there about patient care, ask your nurse (once again briefly) whether you should ask the nurse about these questions or the doctor.  
  • If there are questions about what happens when you get home, save them for the social worker at first & if he/she doesn't have the answer, ask your doctor the next time you see them.   
  • Pick the HIGH PRIORITY questions to ask the doctor when they see you in their morning "rounds." Give these questions to your spokesperson (this may be YOU if you are the patient!)
  •  If you have a complaint, share it after you get the first two key questions done or your entire conversation with the doc will be about that & you will be wasting important data-gathering time.

Important FYI: The doctors will visit all their patients in the morning usually between 6am-10am.  These visits are called "rounds" or "rounding."  If they are a surgeon it will be earlier. If they are in a teaching hospital, the resident will come in early.  If its a community hospital, expect between 8-10am. If a family member wants to ask questions then make sure they are bedside with the patient during these times.

Within a short time period, we docs have to see all our patients & then focus on our sickest ones.  Sometimes we have to attend to our sickest folks first, delaying rounding on everyone else.  This is the way it works. Maybe someday this will change, but this is how the system runs now. 

Do not expect a doc to be able to have a prolonged conversation in the morning.

If you are stable, you may not see the doc again that day.  This may seem strange & honestly, its not really our preference (we'd prefer to see patients more often but it just isn't possible with our workload).  Just know that we are continuing to monitor you throughout the day and remember that everything is a balance between all our patients.  

If your/your family member's condition is serious or the patient is in the ICU or in Rehab, ask for a "family meeting" to be scheduled with the doc to provide a thorough discussion of what is going on with the patient with the whole family present.

Next Post:  How To Get The BEST Medical Care: Insider Tips From A Doc! Tips #3 &4: Key Question to Ask the Doctor in the Hospital & Key Things You Need to Know About Yourself!! (Part 2 of 5)

Coming Up AFTER Thanksgiving:

  • SuperImmunity Foods for KIDS (Calling All PARENTS!)
  • RECIPES & Ideas: Snacks!  YUMMY & Portable Plant-Based Snack Food--all sugar-free, gluten-free & without adding oil or fat!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.


  1. Dr. Cat,

    I have read all your tips thus far and really appreciate your taking the time to post this information. The Happy Rehab Doc sounds like the name of a good book title too!

    I'm seeing my pain doctor this afternoon and am a little nervous about the questions I typed up. I edited and
    re-edited like you said, but am still hoping it is not too much while at the same time trying to make sure I get all my questions answered because the doctor is not easy to get in to see, so I must make the most of my appointment.

    Do you mind evaluating this? If not, that's fine. I just thought I'd ask. :)

    1. Nerve block did not work. What is causing the pain????

    2. Stopped Metaxalone due to depression and vivid, nightmares every night. Is there a different muscle relaxer I can try?

    3. Decreased Cymbalta to 30 mg. Having nightmares and night terrors every night.
    (Night terrors must stop or back will not get better) Brain chemicals are obviously off. Could lowering the Cymbalta have caused this???

    4. Wake up with a headache every day now. Lasts all day. Why???? Medicine for headaches besides Tylenol?

    5. Still have sharp, unexpected hip pain.


    1. I need a refill.

    2. If increasing Cymbalta doesn't stop night terrors, then what is the schedule to get back on Lexapro? Or do I need to increase Trazadone for night terrors?

    3. In emergency, can I take Vicodin w/ Cymbalta?

    4. If the constipation schedule doesn't work when I increase Cymbalta during the holidays, then what is Plan B?

  2. Hey Christy! You just caught me! You are very sweet on the book title comment:-) I just really want people to know about this stuff! I think it is very important in life to be of service to others.

    You don't need to be nervous--your questions are wonderful and even though most Pain docs are in a rush because they have a high volume of patients, giving them questions is so important. Just take a DEEP BREATH before you get there and think about how much you will be helping your doctor treat you better.

    A few tips (and remember my medical disclaimer below--I am NOT your doctor and I do not know your clinical picture so I am NOT giving you guidance as a patient of mine:-):

    1st: I would write down your list very clearly and take 3 copies with you.
    1) Give 1 to the receptionist at check-in and ask her to give it to your doctors nurse so your doc can look over the questions (if they have time) before entering your room.
    2) Give 1 to the doc when he/she walks in the room--just say: "I made this brief list because I want to make sure that I ask you the questions I have but also help you stay on schedule because I know you are very busy" (the doc will LOVE this statement).
    3) keep one in your lap with something hard to write on. leave enough room after each question on your copy so you can write down AS THE DOC IS TALKING so before they leave the room you can *quickly* repeat what they said so you make sure you understand.

    2nd Here are some comments on your questions. I would also do a quick summary before you start: "Doc I have a few questions about why the nerve block didn't work, how I can stop getting nightmares since I changed my medications and I am concerned about me having daily headaches).

    One additional comment--ask the doc if you REALLY need all those meds. I believe that they interact with each other (look at the "PILL ADVISED" link I have on the left bar of the blog to do your own research--its under the category titled "Medical Resources"before "Meditations.") and some of the combined reactions may be worse than the problem they are treating. Ask also whether another round of Physical Therapy would be helpful (even if you have done it before!)

    Here are comments:
    2 &3: (I would combine 2 & 3 and say: I'm having nightmares and night terrors every night. could cause be:
    1) stopping Metaxalone or
    2) Cymbalta dose reduction?
    3) what next, are there alternatives for these meds?)

    4. I would make sure you describe the headache and what makes it go away and what makes it worse)

    Hope that helps! Your Cymbalta questions are great, I have no comments!

    Great job!! Hope this advice helps!

  3. God Bless You, Dr. Cat!!! Your recommendations are SO helpful! I'm off to make adjustments to my list now. Have a fantastic day!

  4. Just got back from my doctor's appointment. She said that she really liked my list because it gave her a chance to read over my questions and think about options before she entered the room.

    I can also say that without that list I have NO doubt that I would have left there with something unanswered, because a couple of times she got sidetracked and looking at the list I realized that she was about to end our visit without addressing my headaches or a Plan B for the holidays.

    The list kept us both on track, got all my questions answered and I'm so glad she liked it!

    Plus, I now have all my answers neatly written after each question, which I was able to read back to her for verification. And on top of that, if it hadn't been for me writing down her answers, we could have had a medical mistake, because at one point, I thought she was talking about Flexeril, but she was actually talking about Vicodin. It was when I was reviewing the list with her that we caught the mistake.

    Thank you again, Dr. Cat!

  5. Christy! I thought I had already commented here! When I read your comment about your doctor's visit last week it totally made my day! I'm SO happy you were able to apply my recommendations and get such wonderful benefit from it!! Great job!!

    Hope you will email friends and family with links to these tips so that they too will benefit--I just think it makes SUCH a difference in the quality of your medical care (which is my mission on this blog!!)


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