Preparing for Hospitalization

Courtesy John Dempsey HospitalThere are many things you need to consider as you prepare to enter the hospital. You can improve your care or the care of a family member by taking an active role in the healthcare process. This section will outline the questions you should ask to help you understand your condition, medication, and the options for care.

The issues outlined in the section include: (click to go directly to the desired option)

Are you scheduled to have medical tests?

Before a treatment decision is made, your doctor needs to make a diagnosis. Medical tests are an important way to help your doctor learn about the problem. It is important to make sure that any tests your doctor suggests are appropriate for you.

Ask:

  • What is the test for?
  • How is the test done?
  • Will the test hurt?
  • How accurate is the test?
  • Is this test the only way to find out that information?
  • What are the benefits and risks of having this test?
  • What do I need to do to prepare for the test?
  • How many times have you performed the test?
  • When will I get the results?
  • What will the results tell me?
  • What's the next step after the test?

You want your tests to be done the right way, and you want accurate results.

  • For tests your doctor sends to a lab, ask which lab he or she uses, and why. You may want to know that the doctor chooses a certain lab because he or she has business ties to it. Or, the health plan may require that the tests go there.
  • Check to see that the lab is accredited by a group such as the College of American Pathologists (800-323-4040) or the Joint Commission (telephone 630-792-5800; website www.jointcommission.org).
  • If you need a mammogram, make sure the facility is approved by the Food and Drug Administration. You can find out by checking the certificate in the facility. Or, call 800-4-CANCER 9:00 a.m.-4:30 p.m. EST to find out the names and locations of certified facilities near you.

What about the test results?

  • Do not assume that no news is good news. If you do not hear from your doctor, call to get your test results.
  • If you and your doctor think the test results may not be right, have the test done again.

Did you recently receive a diagnosis?

Ask:

  • What is my diagnosis?
  • What is the technical name of my disease or condition, and what does it mean in plain English?
  • What is my prognosis (outlook for the future)?
  • What changes will I need to make?
  • Is there a chance that someone else in my family might get the same condition?
  • Will I need special help at home for my condition?
  • Is there any treatment?
  • What are my treatment options?
  • How soon do I need to make a decision about treatment?
  • What are the benefits and risks associated with my treatment options?
  • Is there a clinical trial (research study) that is right for me?
  • Will I need any additional tests?
  • What organizations and resources do you recommend for support and information?

Are you considering treatment for an illness or condition?

If you understand and feel comfortable with your treatment plan, you are more likely to do your part to make it work. Research shows that people who are actively involved in their own healthcare tend to get better results.

Ask:

  • What are my treatment options?
  • What do you recommend?
  • Is the treatment painful?
  • How can the pain be controlled?
  • What are the benefits and risks of this treatment?
  • How much does this treatment cost?
  • Will my health insurance cover the treatment?
  • What are the expected results?
  • When will I see results from the treatment?
  • What are the chances the treatment will work?
  • Are there any side effects?
  • What can be done about them?
  • How soon do I need to make a decision about treatment?
  • What happens if I choose to have no treatment at all?

The next step is for you and your doctor to look at your treatment options. Your doctor may recommend one or more of the following:

  • Behavior change (for example: eating a healthier diet, getting more exercise, quitting smoking).
  • Prescription medicine.
  • Non-prescription ("over-the-counter") medicines.
  • Surgery.
  • Rehabilitation (such as physical therapy).
  • Other treatments (for example, chiropractic services, massage, or acupuncture).
  • "Watchful waiting." (You and your doctor keep track of your symptoms and watch for any changes. If there are changes, then treatment might be the next step.)

Not all treatments have been proven by research studies to work or to be the best treatment for what you have. "Clinical practice guidelines" can help doctors and patients make the right treatment choices for some conditions. Some of these guidelines are based on scientific evidence about which treatments work for certain conditions and which do not. Ask your doctor if there are evidence-based guidelines on treatments for your condition.

Ask about any books or special materials that can help you decide which treatment is best for you. For example, "shared decision-making programs" use video, audio, and computer graphics to help patients make decisions based on science and on their own values and preferences. Self-help groups, patient organizations (such as the American Cancer Society and the American Diabetes Association), the Internet, and your library are other sources of information.

You might want to make a chart of "Benefits and Risks" or "Pros and Cons" to help you decide if the treatment is right for you. Here is a sample chart:

Benefits (Pros)

Risks (Cons)

  • Treatment has worked well for others with my condition.
  • The medicine only needs to be taken once a day.
  • No major side effects are expected.
  • Some minor side effects (rash, stomach upset) could be troubling.
  • The medicine is costly.

Did your clinician recently recommend surgery?

Some surgery has to be done right away. But most surgery is not an emergency. That means you have time to talk with your doctor and decide what is best for you.

No surgery, not even minor surgery, is risk-free. To decide if a procedure is right for you, learn about it and its possible benefits and risks. Research shows that patients who know the facts about surgery and other treatments can better work with their doctors to make decisions based on science and on what the patient prefers.

Ask:

  • Why do I need surgery?
  • What kind of surgery do I need?
  • What will you be doing?
  • What are the benefits and risks of having this surgery?
  • Have you done this surgery before?
  • How successful is this surgery?
  • Which hospital is best for this surgery?
  • Will the surgery hurt?
  • Will I need anesthesia?
  • How long will the surgery take?
  • How long will it take me to recover?
  • How long will I be in the hospital?
  • What will happen after the surgery?
  • How much will the surgery cost?
  • Will my health insurance cover the surgery?
  • Is there some other way to treat my condition?
  • What will happen if I wait or don't have this surgery?
  • Where can I get a second opinion?

 

What to ask about surgery, in more detail.

Ask your surgeon to explain the surgery and how it is done. Your surgeon can draw a picture or a diagram and explain the steps in the surgery.

Is there more than one way of doing the operation?

One way may require more extensive surgery than another. Some operations that once needed large incisions (cuts in the body) can now be done using much smaller incisions. Instead of a large scar, you will have only a few small scars. Usually, you will recover from this type of surgery more quickly. These incisions let doctors insert a thin tube with a camera (a laparoscope) into the body to help them see. Then they use small tools to do the surgery. This type of surgery is called laparoscopic surgery. Removing the gallbladder, for example, is now mostly done with this type of surgery.

Are There Alternatives To Surgery?

Sometimes surgery is not the only answer to a medical problem. Medicines or treatments other than surgery, such as a change in diet or special exercises, might help you just as well—or more. Ask your surgeon or primary care doctor about the benefits and risks of these other choices. You need to know as much as possible about these benefits and risks to make the best decision.

One alternative to surgery may be watchful waiting. During a watchful wait, your doctor and you check to see if your problem gets better or worse over time. If it gets worse, you may need surgery right away. If it gets better, you may be able to wait to have surgery or not have it at all.

How Much Will the Operation Cost?

Even if you have health insurance, there may be some costs for you to pay. This may depend on your choice of surgeon or hospital. Ask what your surgeon's fee is and what it covers. Surgical fees often also include some visits after the operation. You also will get a bill from the hospital for your care and from the other doctors who gave you care during your surgery.

Before you have the operation, call your insurance company. They can tell you how much of the costs your insurance will pay and what share you will have to pay. If you are covered by Medicare, call 1-800-MEDICARE (1-800-633-4227) to find out your share of surgery costs.

What Are the Benefits of Having the Operation?

Ask your surgeon what you will gain by having the operation. For example, a hip replacement may mean that you can walk again with ease.

Ask how long the benefits will last. For some procedures, it is not unusual for the benefits to last for a short time only. You may need a second operation at a later date. For other procedures, the benefits may last a lifetime.

When finding out about the benefits of the operation, be realistic. Sometimes patients expect too much and are disappointed with the outcome or results. Ask your doctor if there is anything you can read to help you understand the procedure and its likely results.

What Are the Risks of Having the Operation?

All operations have some risk. This is why you need to weigh the benefits of the operation against the risks of complications or side effects.

Complications are unplanned events linked to the operation. Typical complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions. There also may be side effects after the operation.

Often your surgeon can tell you what side effects to expect. For example, there may be swelling and some soreness around the incision.

There is almost always some pain with surgery. Ask your surgeon how much pain there will be and what the doctors and nurses will do to help stop the pain. Controlling the pain will help you to be more comfortable while you heal. Controlling the pain will also help you get well faster and improve the results of your operation.

What If I Don't Have This Operation?

Based on what you learn about the benefits and risks of the operation, you might decide not to have it. Ask your surgeon what you will gain—or lose—by not having the operation now. Could you be in more pain? Could your condition get worse? Could the problem go away?

Getting a Second Opinion

A "second opinion" is when another doctor gives his or her views about what you have and how it should be treated. A second opinion can help you decide whether the surgery is right for you at this time. Your doctor and surgeon should welcome your request for a second opinion. Your health plan may even require one for some types of surgery.

You can ask your doctor, health plan, a local medical school, or local medical society for help in finding someone to give you a second opinion. But first check to see if your health plan covers second opinions.

Making Sure Your Surgery is Safe

Check with your insurance company to find out if you may choose a surgeon or hospital or if you must use ones selected by the insurer.

If you do have a choice of surgeon, ask the following questions:

What are your qualifications?

You will want to know that your surgeon is experienced and qualified to perform the operation. Many surgeons have taken special training and passed exams given by a national board of surgeons. Ask if your surgeon is "board certified" in surgery. Some surgeons also have the letters F.A.C.S. after their name. This means they are Fellows of the American College of Surgeons and have passed another review by surgeons of their surgical skills.

How much experience do you have doing this operation?

One way to reduce the risks of surgery is to choose a surgeon who has been well trained to do the surgery and has plenty of experience doing it. You can ask your surgeon about his or her recent record of successes and complications with this surgery. If it is easier for you, you can discuss the surgeon's qualifications with your primary care doctor.

Selecting a Hospital

Ask your doctor about which hospitals have the best care and results for your condition if you have more than one hospital to choose from.  Most surgeons work at one or two local hospitals. Ask your doctor, your surgeon, and the hospitals for information about the number of surgeries like yours done at each hospital and success rates.  Research shows that patients often do better when they have surgery in hospitals with more experience in the operation.  Check with the hospitals for other information on their surgical services.

For more information on hospital surgical safety, click here.

Ask the Surgeon How Long You Will Be in the Hospital

Until recently, most patients who had surgery stayed in the hospital overnight for one or more days. Today, many patients have surgery done as an outpatient in a doctor's office, a special surgical center, or a day surgery unit of a hospital. These patients have an operation and go home the same day. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room.

Ask whether your operation will be done in the hospital or in an outpatient setting, and ask which of these is the usual way the surgery is done. If your doctor recommends that you stay overnight in the hospital (have inpatient surgery) for an operation that is usually done as outpatient surgery—or recommends outpatient surgery that is usually done as inpatient surgery—ask why. You want to be in the right place for your operation.

What Kind of Anesthesia Will I Need?

Anesthesia is used so that surgery can be performed without unnecessary pain. Your surgeon can tell you whether the operation calls for local, regional, or general anesthesia and why this form of anesthesia is best for your procedure.

  • Local anesthesia numbs only a part of your body and only for a short period of time. For example, when you go to the dentist, you may get a local anesthetic called Novocain. It numbs the gum area around a tooth. Not all procedures done with local anesthesia are painless.
  • Regional anesthesia numbs a larger portion of your body—for example, the lower part of your body—for a few hours. In most cases, you will be awake during the operation with regional anesthesia.
  • General anesthesia numbs your entire body. You will be asleep during the whole operation if you have general anesthesia.

Anesthesia is quite safe for most patients. It is usually given by a specialized doctor (anesthesiologist) or nurse (nurse anesthetist). Both are highly skilled and have been trained to give anesthesia.

If you decide to have an operation, ask to meet with the person who will give you anesthesia. It is okay to ask what his or her qualifications are. Ask what the side effects and risks of having anesthesia are in your case. Be sure to tell him or her what medical problems you have—including allergies and what medicines you have been taking. These medicines may affect your response to the anesthesia. Be sure to include both prescription and over-the-counter medicines, like vitamins and supplements.

How Long Will It Take Me To Recover?

Your surgeon can tell you how you might feel and what you will be able to do—or not do—the first few days, weeks, or months after surgery. Ask how long you will be in the hospital. Find out what kind of supplies, equipment, and help you will need when you go home. Knowing what to expect can help you get better faster.

Ask how long it will be before you can go back to work or start regular exercise again. You do not want to do anything that will slow your recovery. For example, lifting a 10-pound bag of potatoes may not seem to be "too much" a week after your operation, but it could be. You should follow your surgeon's advice to make sure you recover fully as soon as possible.

Here are some places you can get more information.

Surgery

The American College of Surgeons (ACS) has free pamphlets on When You Need an Operation. For copies, write to:

The American College of Surgeons
Office of Public Information
633 N. St. Clair Street
Chicago, IL 60611
Phone: (312) 202-5000 (toll free: 1-800-621-4111)

This group has pamphlets that give general information about surgery and other pamphlets that describe specific surgical procedures. These pamphlets are also available on the ACS Web site at http://www.facs.org/public_info/ppserv.html.

Second Opinion

For the free brochure, Getting a Second Opinion Before Surgery: Your Choices and Medicare Coverage, write to:

Centers for Medicare & Medicaid Services
Room 555, East High Rise Building
6325 Security Boulevard
Baltimore, MD 21207
Ask for Publication No. CMS 02173.

The brochure can also be found on the CMS Web site at http://www.medicare.gov/Publications/Pubs/pdf/02173.pdf.

For the name of a specialist in your area who can give you a second opinion, ask your primary care doctor or surgeon, the local medical society, or your health insurance company. Medicare beneficiaries may also obtain information from the U.S. Department of Health and Human Services' Medicare hotline; call toll-free 1-800-633-4227.

General

For almost every disease, there is a national or local association or society that publishes patient information. Check your local telephone directory.

There are also organized groups of patients with certain illnesses that may be able to provide information about a condition, alternative treatments, and experiences with local doctors and hospitals. Ask your hospital or doctors if they know of any patient groups related to your condition.

Also, your local public library has medical reference materials about healthcare treatments. Many libraries now have Health Information Centers, special sections with books and pamphlets on health and disease. Your librarian also can help you find trusted sources of medical information on the Internet.