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38 Secrets Hospitals Won’t Tell You

No-one looks forward to a health crisis, but our insights and tips will help you get better care, cut costs – and get out alive.

Pick the Right Place

1. For complex surgical procedures, you’re generally better off at teaching hospitals, which usually stay at the forefront of health research. Medical students and residents ask questions, providing more eyes and ears to pay attention and prevent errors. Teaching hospitals have lower complication rates and better outcomes.
Dr Evan Levine, cardiologist, author of
What Your Doctor Won’t (or Can’t) Tell You

2. Private patients in public hospitals often assume they will get their own room. But rooms are allocated on medical need. Someone with an infectious disease will always get the single room.
Kate Ryder, nurse, author of An Insider’s Guide to Getting the Best Out of the Health System

3. A good surgeon will tell you all the information you need to know, even the parts that you might not want to hear. That doesn’t mean that a good surgeon will be rude. It means that they will tell you, in a respectful and professional manner, whether the results you want are realistically attainable and safe, the best procedure to achieve your desired result, the risks and possible complications involved in the procedure, whether you are a good candidate for surgery and what the costs will be.
Andrew Ives, plastic surgeon, Melbourne

4. People do themselves a disservice if they drive to a hospital based on its reputation rather than their local facility. Many illnesses are time critical. Also, a visit to hospital might be just the first of many; you might have to return several times for follow ups.
Dr Stephen Parnis, senior emergency physician, Melbourne

The Dirt on Errors and Infection

5. Superbugs live everywhere, and they can travel. Even if your doctor washed his hands, that sparkling white coat brushing against your bed can easily transfer a dangerous germ from someone else’s room. Ask for bleach and alcohol wipes to clean bed rails, controls, doorknobs, phones, call buttons and toilet flush levers. Wash your hands before you eat.
Karen Curtiss, author of Safe & Sound in the Hospital

6. Don’t interrupt the nurse when he’s preparing your medication. Interruptions significantly increased medication error rate. Every time a nurse is interrupted, there’s a 12.7% increase in clinical (dosage) errors and a 12.1% increase in procedural failures, such as failing to check a patient’s ID with their medication chart.
Archives of Internal Medicine
, 2010

7. All those times people ask you the same questions throughout your hospital stay? It’s a safety check and it’s really important. If you have a severe allergy to medication, for example, you need to remind staff every step of the way.
Dr Stephen Parnis

8. Hospitals are dangerous places … and around 10% of us who enter public hospitals experience a preventable mistake or error in our care. Research shows a variety of reasons for non-reporting by health professionals. These include a culture or hierarchy of not reporting: “I don’t do it as it isn’t my job – it’s a nursing role,” a fear management will use reports against clinicians or that the reports will result in disciplinary action, a belief that mistakes are an acceptable part of overworked and underfunded health systems, and a view that reporting is unheard, dismissed or will not make any difference.
Dr Brian Robinson, senior lecturer, Victoria University of Wellington, NZ

9. Ask your nurses to do a “bedside shift change.” This is when they share information in your presence instead of at the nurses’ station. You can better correct any errors. [Studies show it also improves communication and care.]
Karen Curtiss

How the Money Flows

10. The amount being charged by your surgeon bears no relation to his or her level of skill. The Royal Australasian College of Surgeons (RACS) is one of several international organisations calling for surgeons to release more information on the rate of poor outcomes, as there’s currently no way of gauging their performance. In fact, there are surgeons who are outstanding and only charge the scheduled fee, while others may be less skilled yet charge exceptionally high fees, the RACS says.
RACS, 2015

11. Check your hospital bill against your clinical file (you may need to do this at the hospital concerned). If there are tests and scans on your bill that do not have a corresponding entry on your clinical file (check the dates as well as items), you can contest them.
Kate Ryder

Some Ugly Truths

12. Under-resourcing means nurses often have to make difficult decisions about what care is critical for patient survival and what can be left undone. ‘Care rationing’ in New Zealand has left some nurses skipping vital recordings and ignoring call bells, with nurses in flat-out rescue mode, a recent investigation found. It reported that some nurses are so busy helping doctors, organising medications and filing paperwork that they get to spend only about three hours of their shift with patients.
press.co.nz, 2014

13. There is more violence than ever before. Nurses have been attacked, bitten, spat on and choked. In fact, I’m aware of only a handful of nurses who haven’t been victims of some sort of verbal or physical attack. Staff are dealing with more intoxicated patients and people who are suffering methamphetamine-fuelled psychosis. There is an increasing acting out from patients and sometimes it’s relatives, too.
Susanne Trim, New Zealand Nurses Organisatio
n

14. For us the closest mental health unit is 45 minutes away (but they are always full), and the next and most frequently referred to is two hours away. We can wait over 24 hours for transport of a scheduled patient just to see a psychiatrist. This is obviously not safe, it blocks hospital beds [from physically ill patients] and is unacceptable. We have only one mental health room and at times have up to five patients needing acute care.
Regional hospital nurse

15. Medical specialists are often uncomfortable with patients who are dying. ... As patients become even more ill, they are often admitted to intensive care. Up to 70% of people now die in acute hospitals surrounded by well-meaning strangers inflicting all that medicine has to offer, often resulting in a painful, distressing and degrading end to life.
Vital Signs
, by Professor Ken Hillman, University of NSW, Australia

16. A lot of the problems with patients occur because they are withdrawing from drugs or alcohol while in hospital. If you know you are going in, then do some preparation – get nicotine patches or reduce the amount you drink.
Kate Ryder

Our Pet Peeves

17. We see crazy things. I’ve had a patient run stark naked into the ED waiting room. A patient asked me out while I was holding a basin, catching his vomit.
Emergency nurse

18. Most of us hate electronic medical records systems. We don’t like that we have to click off boxes instead of focusing on the patient. The choices they give us to click on don’t give the doctors a real understanding of what we’re doing. A lot of things get missed.
Karen Higgins, nurse

19. As a junior hospital doctor, it was an almost daily occurrence that patients would mistake me for a nurse, student, or anything other than a doctor. You spend 45 minutes with a patient taking a history, performing an examination, taking bloods, explaining their diagnosis and management plan. Then they say “OK, when do I get to see the doctor?” Unfortunately, introducing yourself as a doctor, wearing an ID badge that says Doctor Such-and-Such, draping a stethoscope around your neck and wearing a uniform that has DOCTOR on it does not prevent these assumptions from occurring.
Rural locum doctor, Western Australia

20. The signage in hospitals can be terrible – we have had reports of people not even being able to find their way out.
Associate Professor Michael Greco, patientopinion.org.au

Enjoy Your Stay

21. Bring a clear, printed list of exactly what medications you take at home and when you take them. Don’t just say ‘daily’. We need to know if you take them at night with dinner or when you wake up.
Kevin B. Jones, surgeon, author of
What Doctors Cannot Tell You

22. Nurses sometimes need reminders, so never be afraid to ask for something more than once. We can be juggling so much … we haven’t intentionally forgotten your reques.
Regional hospital nurse

23. Hospitals can be very noisy at night so bring ear plugs. There is no such thing as a dressing gown and slippers in hospital, so bring your own.
Kate Ryder

Health Advice: True or False?

24. It’s best to schedule surgery early in the week. TRUE
On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other services may be unavailable. If you’re having a major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend.
Dr Roy Benaroch

25. No food or liquids eight hours before surgery. FALSE
Many hospitals say no drinking or eating after midnight the day before your surgery because it’s more convenient for them. But that means patients may show up uncomfortable, dehydrated and starving, especially for afternoon surgery. The latest recommendations from the Australian and New Zealand College of Anaesthetists say that for healthy adults having an elective procedure, limited solid food may be taken up to six hours prior to anaesthesia and clear fluids totalling not more than 200 millilitres per hour may be taken up to two hours prior to anaesthesia.
Dr Cynthia Wong, anaesthesiologist

26. Rest to get better. FALSE
Get up and move. Walk the halls, walk to the café, go outside. It will help you avoid blood clots, and patients see psychological benefits. One study found that older patients who get out of bed and walk around reduce their stay by an average of 40 hours.
Dr Roy Benaroch

What We’re Getting Right

27. Every day that I am at work patients are cared for, lives saved and lives lost. What is a constant in the hospital is the people that are employed. Always caring, always willing to go the extra mile to make someone comfortable.
Regional hospital nurse

28. A generation ago, when I started in medicine, there was so much that was untreatable. Just the other day I saw a patient who used to be a severe diabetic with end stage renal failure. When I was at medical school he would have died, no doubt. Now he’s been able to have a kidney and pancreas transplant and I was taken aback when he said he used to be a diabetic and on insulin but he’s not any more.
Dr Stephen Parnis

29. Sixty per cent of the patient feedback we get to our site is positive. We hear of hospitals who are willing to make changes based on what their patients want. We’ve had cases of a CEO putting up temporary signage himself, and another hospital creating a garden in their mental health area, all based on patient feedback.
Associate Professor Michael Greco

Recover Quicker

30. The sooner you can get out of hospital, the better. There are superbugs, it’s unfamiliar and you are more likely to fall in hospital. You’re less mobile and more likely to be in bed and so you are at higher risk of things like infection and blood clots. You’re more likely to recover more quickly in your own home – but we will not discharge you until we think it’s safe.
Dr Stephen Parnis

31. Don’t assume the food is what you should be eating. Patient nutrition is often an afterthought, with doctors needing greater recognition of the nutrition needs of their patients. For elderly patients, particularly, malnourishment could be exacerbated during their hospital stay.
Professor Ian Caterson, Boden Professor of Human Nutrition at the University of Sydney, MJA Insight, 2014

32. Make sure you ask how to manage your condition when you leave hospital. An HCF health insurance fund survey found that 13% of patients weren’t asked whether they would have the help they needed at home, and almost a third were not provided information in writing on symptoms or health problems to look out for when they were discharged.
HCF Survey, 2013

33. Before you leave the hospital, demand that your follow-up appointment be already scheduled. I’ve found that is the single most effective strategy hospitals can use to reduce your chance of readmission, but it still rarely happens. Make sure you’ve been connected to the next person [in the medical process] who will take care of you.
Elizabeth Bradley, professor of public health at Yale University

34. One study found that patients forget 40-80% of what doctors and nurses tell them, even if they’re nodding their heads. Have someone with you to take notes or ask if you can record what the doctor says on a smartphone. The most critical time to record is at discharge, when you receive crucial information about medications and next steps.
Karen Curtiss

35. Get copies of your lab tests, and scans before you leave the hospital, along with your discharge summary and operative report if you had surgery. It can be shockingly difficult for me to get copies of those things.
Dr Roy Benaroch, paediatrician

36. Don’t let loved ones spend the night alone in a hospital. It’s important someone is there if they get confused or need help getting to the bathroom or if their breathing pattern changes. If the hospital has restrictive visiting hours, ask if it will make an ­exception.
Dr Michele Curtis

Our Human Side

37. Every time I operate on a patient I have to remind myself that this patient is a member of my family. It’s so easy to rush an operation if you have got to go to a concert that night. It’s so easy to wake up in a bad mood and go to work and treat your patients badly. It’s so easy to ignore the family who wants to speak to you at 10pm and you want to go home and have dinner and see your kids. I have to consciously say to myself “Charlie, wait, you’re a member of that family. What if that was your child on the table?”
Charlie Teo, neurosurgeon

38. My worst moment ever was on New Year’s Eve in 2008, when the code-blue pager went off. A baby we’d operated on had stopped breathing. Ten of us were frantically doing everything possible, but we couldn’t resuscitate her. I had to tell her parents that their firstborn daughter had died. I was up all night grieving with them. Every New Year’s Eve, I think about them.
Dr James Pinckney



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