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"Oops, wrong kidney."
In recent years, errors in treatment have become a serious problem for hospitals, ranging from operations on wrong body parts to medication mix-ups.
At least 1.5 million patients are harmed every year from being given the wrong drugs, according to the Institute of Medicine of the National Academy of Sciences. That's an average of one person per U.S. hospital per day.
One reason these mistakes persist: Only 10% of hospitals are fully computerized and have a central database to track allergies and diagnoses, says Robert Wachter, the chief of medical service at UC San Francisco Medical Center.
But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, have signed on for a campaign by the not-for-profit Institute for Healthcare Improvement to implement prevention measures such as multiple checks on drugs.
Though the system is improving, it still has a long way to go. Patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right medications are being dispensed.
Infections and the chain of command
"You may leave sicker than when you came in."A week after Leandra Wiese had surgery to remove a benign tumor, the high school senior felt well enough to host a sleepover. But later that weekend she was vomiting and running a fever. Thinking it was the flu, her parents took her back to the hospital. Wiese never came home. It wasn't the flu but a deadly surgical infection.
About 2 million people a year contract hospital-related infections, and about 90,000 die, according to the national Centers for Disease Control and Prevention. The recent increase in antibiotic-resistant bugs and the mounting cost of health care -- to which infections add about $4.5 billion annually -- have mobilized the medical community to implement processes designed to decrease infections. These include using clippers rather than a razor to shave surgical sites and administering antibiotics before surgery but stopping them soon after to prevent drug resistance.
For all of modern medicine's advances, the best way to minimize infection risk is low-tech: Make sure any hospital staffers who touch you have washed their hands. Tubes and catheters are also a source of bugs, and patients should ask daily if they are necessary.
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"Good luck finding the person in charge."
Helen Haskell repeatedly told nurses something didn't seem right with her son Lewis, who was recovering from surgery to repair a defect in his chest wall. For nearly two days she kept asking for a veteran, or "attending," doctor when the first-year resident's assessment seemed off. But Haskell couldn't convince the right people that her son was deteriorating.
"It was like an alternate reality," she says. "I had no idea where to go."
Thirty hours after her son first complained of intense pain, the South Carolina teen died of a perforated ulcer.
In a sea of blue scrubs, getting the attention of the right person can be difficult. Who's in charge? Nurses don't report to doctors but rather to a nurse supervisor. And your personal doctor has little say over radiology or the labs running your tests, which are managed by the hospital.
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Some facilities employ "hospitalists" -- doctors who act as point people to conduct flows of information. Haskell urges patients to know the hospital hierarchy, read name tags, get the attending physician's phone number and, if all else fails, demand a nurse supervisor, likely the highest-ranking person who is accessible quickly.
"Everything is negotiable, even your hospital bill."
When it comes to getting paid, hospitals have their work cut out for them. Medical bills are a major cause of bankruptcy in the U.S., and when collectors are put on the case, they take up to 25% of what is reclaimed, according to Mark Friedman, the founder of billing consultant Premium HealthCare Services. That leaves room for some bargaining.
Take Logan Roberts. The 26-year-old had started work as a business analyst near Atlanta but had no insurance when he was rushed to an emergency room for an appendectomy. The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America.
Roberts was billed $21,000. "I was like, holy cow!" he says. "That's four times my net worth."
After advice from advocacy group The Access Project, Roberts spoke with hospital administrators, telling them he couldn't pay in full. Hospitals frequently work with patients, offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial-assistance office. It paid off for Roberts, whose bill was sliced to $4,100, 20% of the original.
Be smart about bills
"Yes, we take your insurance, but we're not sure about the anesthesiologist."The last thing on your mind before surgery is making sure every doctor involved is in your network. But since the answer is often no for anesthesiologists, pathologists and radiologists, what's a patient to do?
Los Angeles entertainment lawyer and patient advocate Michael A. Weiss repeatedly turned away out-of-network pain-management doctors on a recent visit to a hospital.
You don't necessarily need to go as far as Weiss did, but do ask for someone in your network if you're alert enough. If it's an emergency and you're stuck with an out-of-network doctor, call your insurance company to help resolve the issue. If it's elective surgery, ask a scheduling nurse in the surgeon's office to find specialists in your plan, says South Bend, Ind., billing sleuth Mary Jane Stull.
If you know your procedure will be out of network, call the hospital billing department to negotiate. It will likely point you to a patient representative or the director of billing. Once you've dealt with the hospital, then try the surgeon or other specialists involved -- some hospitals will back you in those discussions, Friedman says.
Continued: Sometimes we bill you twice
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