Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out

By David Sherer

WHY YOU SHOULD NEVER HAVE AN OPERATION IN JULY AND OTHER LIFESAVING ADVICE!

"This book offers practical advice about how to keep yourself free from harm and error in hospitals, and how to assert yourself in cases such as getting stuck with a bad roommate or a rude doctor. Includes chapters on taking children to the hospital and how to be prepared before an emergency." — The Wall Street Journal

Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out  is the essential patient handbook to ensure that you and your family emerge from hospital visits healthier than before checking-in and without having to endure excessive stays, pain or indignities. Includes practical tips, warnings and surprising information you doctor might not tell you, such as the fact that July, when the new interns start, is the most dangerous month to have a procedure done at a teaching hospital; EMLA anesthetic cream can be requested to be used on children’s skin, allowing for less painful I.V. starts; and washing off all iodine-based antiseptics thoroughly after surgery can prevent chemical burns. Proven tips for reducing hospital bills are also presented.

Dr Sherer will teach you how to:

• Find the Best Hospital for Your Condition
• Demand & Receive the Best Care
• Avoid Unnecessary Pain & Complications
• Protect Your Health from Human Error
• Navigate Emergency Room Care
• Educate Yourself on Your Condition & Your Rights
• Protect Your Financial Health & Reduce Your Bills
• Choose Between Bundling Services Versus “Fee for Service” – Pricing/Pros & Cons
• Work the System to Get What You Need
• Maximize New and Innovative Ways to Use the Internet for Self-Education
• Deal with the Impact of Pandemic Emergencies, Natural Disasters and the Opioid Crisis on Your Care
• Learn More about Artificial Intelligence, Robotic surgery and Using Big Data
• Decide if “Medicare for All” is Feasible and the Social Determinants on the Allocation of Healthcare
• And Much Much More!

"I recommend this book for everyone, especially people who are undergoing their first operation in a hospital. Being aware of the services offered or not offered in the hospital and learning ways to reduce anxiety can be invaluable throughout one’s hospital stay. For health care providers, the Hospital Survival Guide offers excellent insight into many of the uncertainties that patients face as they enter into the unknown world of the hospital. Even though we hear the alarming statistics every day, the book is a powerful reminder of all of the mistakes that can be made in the course of care and what we all can do to reduce the likelihood of experiencing a medical error ourselves." — P&T® Journal

• Language: English
• Publisher: Humanix Books
• Release date: Aug 11, 2020
• ISBN: 9781630061647

David Sherer

David Sherer MD (Chevy Chase, MD) is an American physician, author and inventor. He is a member of Leading Physicians of the World, and a multitime winner of HealthTap’s leading anesthesiologists award. Dr. Sherer has retired from his clinical anesthesiology practice in the suburbs of Washington, DC, and now focuses on patient education, writing and patient advocacy; including as a medical and health video commentator for Bottom Line Inc.'s What Your Doctor Isn't Telling You columns and podcasts. He holds two US patents in the fields of critical care medicine and telecommunications. Appearing in all forms of media, Dr Sherer is a tireless advocate for hospitalized patients, and believes that individual responsibility, and not government intervention, is the key to improving the general health and wellbeing of all Americans. https://bottomlineinc.com/source/david-sherer The author lives & works in the Washington DC metro area.

Book preview

Hospital

Survival

Guide

Hospital

Survival

Guide

The Patient Handbook to

Getting Better and Getting Out

DAVID SHERER, M.D.

HOSPITAL SURVIVAL GUIDE

Copyright © 2020 by David Sherer

All rights reserved

Humanix Books, P.O. Box 20989, West Palm Beach, FL 33416, USA

www.humanixbooks.com | [e-mail]

No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any other information storage and retrieval system, without written permission from the publisher.

Humanix Books is a division of Humanix Publishing, LLC. Its trademark, consisting of the words Humanix Books, is registered in the Patent and Trademark Office and in other countries.

Disclaimer: The information presented in this book is not specific medical advice for any individual and should not substitute medical advice from a health professional. If you have (or think you may have) a medical problem, speak to your doctor or a health professional immediately about your risk and possible treatments. Do not engage in any care or treatment without consulting a medical professional.

ISBN: 978-163006-163-0 (Paperback)

ISBN: 978-163006-164-7 (E-book)

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

To all my medical teachers; past, present, and future.

Contents

FOREWORD

How This Book Can Help Make Your Hospital Stay Safe and Comfortable

CHAPTER 1

Choosing the Best Hospital for Safety and Comfort

CHAPTER 2

You Need a Procedure or Surgery—Now What?

CHAPTER 3

The Pre-surgery or Pre-procedural Interview

What Every Patient Needs to Know

CHAPTER 4

Anesthesia and Pain Relief

How to Make Sure Your Doctor Knows What It Takes to Keep You Out of Pain

CHAPTER 5

Taking Care of Business

Insurance, Advance Healthcare Directives, Wills, and Other Matters

CHAPTER 6

Getting Ready to Go

Packing and Other Practical Details

CHAPTER 7

In the Hospital

CHAPTER 8

When Your Child Has to Go to the Hospital

CHAPTER 9

When You Have No Time to Plan

Advice for Emergency Room Patients

CHAPTER 10

Working the System to Get What You Need

CHAPTER 11

Leaving the Hospital … and Beyond

CHAPTER 12

Using the Hospital in Times of National Crisis

AFTERWORD

What Will the Future Look Like for Hospitals and Healthcare?

APPENDIX A

Sample Medical Emergency ID Card

APPENDIX B

Common Outpatient (Same Day) Procedures

APPENDIX C

Hospital Jargon: A Sample Dialog (with Translation)

APPENDIX D

Useful Websites

APPENDIX E

Glossary of Hospital Terms

Index

Foreword

How This Book Can Help Make Your Hospital Stay Safe and Comfortable

This second updated edition of my Hospital Survival Guide is presented with the benefit of examining and analyzing almost two decades of changes in hospital care, changes that in many ways reflect the evolution of healthcare in that same time period. Innumerable improvements in technology, particularly with regard to artificial intelligence and advances in robotic surgery, represent one large area of change. Another is the attention paid to pharmacy spending within hospitals, where up to 20% of a hospital’s operating budget goes. Still another is the staffing challenges, where a critical shortage of nurses and the coming doctor deficit in our country will have a huge impact on an aging and increasingly chronically ill population. Also, the way doctors and hospitals get paid is an area of continuing evolution: The old fee-for-service model is being replaced, in many instances, by bundling and other payment systems that rely on meeting certain predetermined performance metrics.

Some of these changes will directly affect you and the experience you have in the hospital. Others will be less impactful. I will present them nonetheless to give you a better understanding of the developing trends in healthcare, and particularly in hospital care, and the direction in which they are heading.

But none of that has changed the real intention behind this book: to help you the patient endure what is often a stressful and unpleasant experience. After all, no one I’ve ever met truly wants to have anything to do with hospitals.

To determine what information to put in this book, I looked back at a lifetime spent dealing with medical issues and nearly 40 years of my own interaction with patients. By lifetime, I mean the years before medical school, when I learned about illness, hospitals, and sickness-induced human suffering from my father, a doctor, and my mother, a former operating room nurse. When I was about 7 years old, I would go on rounds with my dad, who practiced medicine up until the last year of his life at age 87. For 57 years, my dad was a physician—diagnosing, healing, and at times even suffering with his patients. Through these experiences, I witnessed how scared and uncomfortable people could be because they were ill and in the hospital. All of that made a strong impression upon me. But it was another important person in my young life who fueled my desire to help patients feel safer and more comfortable—my late sister. Her frequent complications from severe diabetes made her a revolving-door hospital patient for much of her all-too-brief life.

In short, the driving impetus behind this book emanates from a broad range of personal relationships and personal experiences, forces within me that exist even after I retired from clinical medicine in 2019. There was no triggering incident, no particular horror story behind it. My family background and the daily experience I had as a doctor seeing patients who were scared and uncomfortable were sufficient motivation for me to write this book to make the whole patient experience better. Patients, perhaps even more than when this book first appeared in 2003, still desperately want to regain some control over their lives.

As an anesthesiologist, I commonly saw patients at the height of their confusion and vulnerability. My presence reminded them that surgery was imminent, and that realization lead them to ask as many questions as they could before being hurried off to surgery. The hospital gown that leaves private parts exposed, and that hideous shower cap to cover your hair are only the external trappings of the control you relinquish. All of a sudden you realize: This is for real—I’m going to be unconscious in a room full of strangers, gadgets, and very sharp implements. Just then, you crave the details of your impending experience and wish you knew if anything could be done to make it better.

Every day before I administered anesthesia, I heard a stream of What ifs? and Then whats? That got me thinking that most of the questions I got at this point in the process ought to have been answered far earlier. The answers and reassurances people were seeking should have come from the patients’ own primary care physician, surgeon, specialist, the nursing staff, or even, in some cases, the health insurance plan or company. Because I may not have had the time to give the needed answers, the patient ended up going into surgery feeling more anxious than ever.

That shouldn’t happen. I firmly believe patients have a right to know, if they wish, salient details concerning what was to be done to their bodies and what the recovery period was going to be like while in the hospital. This includes the long-term prospects for recovery as well. In this book, you’ll find out how to get that information from the right source and at the right time—as well as what to do if you receive unsatisfactory or unintelligible answers.

From the start to finish of your hospitalization, you have a right to expect that medical professionals will respect you and respond to your needs in a professional manner. There’s a flip side to your expectations, though. The hospital staff has a right to expect you to be open and honest about your condition and to be reasonable about the things you want done for your comfort. They’ll need you to be calm and cooperative, at least to the extent that you can manage it, while you’re being poked and interrogated. They should understand that waking you up at four o’clock in the morning to check vital signs or draw blood will likely, and justifiably, make you frustrated and angry with the system. Hopefully, you’ll realize that they’re not just waking you up out of a sadistic desire to deprive you of sleep, but because there is some clear medical purpose for doing so that can’t be postponed. (If, however, they are waking you for a reason that could well be postponed, this book will tell you how to get them to not do it!)

To assist in making your hospital stay safe and comfortable, I will address the most frequently asked patient questions, plus many others you may not have thought of. I will alert you to potentially deadly medical errors and point out some of the small but annoying things about hospital care that you can learn to avoid, once you’ve been warned about them. I will also tell you stories of real people and their experiences (although I have changed the names and other identifying information for those individuals who requested anonymity). All in all, this book will be your insider’s guide to make the hospital system work for you, so that you can endure the safest and most comfortable hospital stay possible.

Please carry this book with you if you have to go to the hospital or, if you’re unable to care for yourself or understand the material presented, have a patient advocate carry it for you. Not everyone is lucky enough to have a spouse, relative, trusted friend, or other person ready to act in that capacity, but it is very important, if at all possible, to find such a person to assist you. Armed with this book and their assistance, patients will be telling, I trust, less nightmare-like stories (replete with medical mishaps and personal indignations) and more tales of comprehension, mutual cooperation, and empowerment.

David Sherer, M.D.

Hospital

Survival

Guide

CHAPTER 1

Choosing the

Best Hospital for

Safety and Comfort

You might think that the days of drably painted green walls and linoleum floors in hospitals are a thing of the past, but you might find yourself wrong. Although there have been enormous efforts expended to improve the look, feel, and overall ambiance of hospitals, the key factor is still, as always, money. If money makes the world go around, it certainly makes the healthcare world go around as well. The wealth of a community is often reflected in the way the local hospitals have evolved and improved. Surely, efforts to improve inner-city hospitals, the type likely to care for those poorer than the general population, have resulted in better care and outcomes for citizens in cities as diverse as Miami, Boston, Atlanta, and Chicago. Much of this is the result of gentrification, where former poverty areas have been gradually redesigned and redeveloped to become affluent and hip urban centers. But in areas more rural, where the tax base and financial picture is not so rosy, hospitals often lag behind other institutions in refurbishing, modernizing, and improving. This can result in patients having to travel great distances, if they can afford it, to get the specialized and sophisticated care they sometimes need.

An article that appeared in the September 11, 2018 edition of The Journal of the American Medical Association entitled Types of Hospitals by Jason Liu and Rachel Kelz is instructive on many fronts. The authors suggest the following questions be asked:

• Which hospital is best for my condition?

• Should I go to a teaching hospital?

• Will I need more than one hospital?

• Is the hospital my only choice?

Once at the chosen hospital, the authors offer additional questions to be asked:

• Is care for my condition routine here?

• How do I talk to my doctor while I’m here?

• What can I do to ensure my safety?

• Can my caregiver or advocate stay in my room with me?

The article goes on to pose other important questions concerning night and weekend staffing, nurse-to-patient ratios, if the hospital has the full-time presence of a doctor, and whether there is an intensive care unit.

The doctors who authored the article categorized hospital type much as I did in my original 2003 book. Embodied in the more than 5,000 hospitals in the United States (which incidentally, house approximately 1 million hospital beds), they break them down into these broad categories:

• Community hospitals (2/3 in large cities, ranging in size from 6 to 500 or more beds). Some may be teaching hospitals.

• Federal government hospitals (200 or so, overseen by the Department of Defense, Department of Health and Human Services, and the Veterans Health Administration).

• Nonfederal psychiatric care (more than 400 in the private sector).

• Nonfederal long-term care (providing medical and rehab services for extended periods).

This classification is but one method to distinguish one hospital from another. The chart within this chapter, devised by me, is but another. There is overlap to be found.

Finding a good hospital isn’t exactly like finding a good inn or resort but, as with any service-oriented experience, reviews are to be found if you look for them. You could ask friends to recommend someplace where they or a significant other had a good experience for the same type of medical issue. You could inquire about things not only relevant to your potential medical outcome, but also ask about factors you really understand and appreciate, like the quality of the food, the feel of the bed linens, and the friendliness and efficiency of the staff. Unfortunately for most patients, the choice over where to go for care involves far more than the physical comforts of the place. You’ll need to find out how often the particular procedure or treatment protocol you’ll be having is performed at various hospitals and what kinds of outcomes each hospital has. You’ll want to know about the availability of advanced equipment and new treatment techniques (and you’ll probably have to learn a lot of new terms, even to ask the right questions). You’ll be concerned with what other medical experts, reviewers, and the media have to say about the hospital—and much, much more.

The authors of the JAMA article have included these very helpful web links to assist you further in choosing the right hospital for you:

• Medicare Guide to Choosing a Hospital www.medicare.gov/pubs/pdf/10181-Guide-Choosing-Hospital.pdf

• Medicare Steps to Choosing a Hospital Checklist https://www.medicare.gov/sites/default/files/2018-07/hospital-checklist.pdf

• American Hospital Association www.aha.org/research/rc/stat-studies/fast-facts.shtml

Getting the answers to these kinds of questions may seem a daunting task. It needn’t be, if you approach it step by step, starting with the following tip:

Let your surgeon assist you in choosing hospitals.

Once you’ve found a physician or surgeon you like and trust, you’ve found your best advisor about where to have the treatment or procedure performed. Your doctor will tell you to which hospitals he or she is allowed to admit patients.

Many doctors have privileges at more than one, which means you can choose among them, based on your own evaluation of the pros and cons. You should consider many, many factors—both practical and medical—as you make your choice, among them: hospital reputation; availability of the services you need; location; parking; visiting hours and other visitor policy matters (such as, Are there limits on how many visitors?); room size and availability of private rooms; food; religious affiliation; and many others discussed in this chapter.

One of the biggest factors in your choice—and for all but the richest patients, the most limiting factor—is the sort of health insurance or health plan you have. Always check with your insurance company or health plan before scheduling any treatment or surgery. (More on this point in Chapter 5, Taking Care of Business.)

Not all the factors influencing your hospital choice are equal. Questions involving your comfort and convenience are important, of course, but unless your treatment or surgery is the most routine sort, done with minimal complexity or invasiveness, you’ll want to assign the highest priority to finding the hospital with the best track record for good outcomes for what you’ll be undergoing.

Don’t assume that your doctor will be collecting such statistics for you. In most cases, it will be up to you to weigh the pros and cons of the different hospitals yourself and make a choice. The sections that follow suggest ways to find the information you seek.

Check accreditation.

Since 1951, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has worked, through its system of accreditation, to improve the safety and quality of care provided to the public. The JCAHO evaluates and accredits thousands of healthcare organizations in the United States, including hospitals, healthcare networks, managed care organizations, and healthcare organizations that provide home care, long-term care, behavioral healthcare, laboratory, and ambulatory care services. A not-for-profit group, the JCAHO is considered the world’s leading healthcare standards–setting and accrediting body.

To conduct the accreditation survey, the JCAHO employs hundreds of physicians, nurses, healthcare administrators, medical technologists, psychologists, respiratory therapists, pharmacists, durable medical equipment providers, and social workers.

During a JCAHO audit, a survey team of the board considers safety practices, adherence to Occupational Safety and Health Administration (OSHA) standards, recordkeeping, drug control procedures, patient rights, and many other areas. To earn and maintain accreditation, an organization must undergo an on-site survey periodically. Laboratories must be surveyed as well.

Organizations can get a passing grade, or a passing grade with commendation; they can also be put on probation, or even shut down. The JCAHO provides a comprehensive guide on the Internet to help individuals learn more about the quality of healthcare organizations. Go to www.jcaho.org and click on the link to Quality Check® to see the list of the JCAHO-accredited healthcare organizations and programs in the United States. The Quality Check listing includes each organization’s name, address, telephone number, accreditation decision, accreditation date, and current accreditation status and effective date. You can also check the individual performance reports for many accredited healthcare organizations. Performance reports provide more detailed information about an organization’s operations, including comparisons with similar organizations. Copies of certain reports aren’t available online, but you can get them by calling the JCAHO’s Customer Service Center at 630-792-5800.

To be sure the hospital’s rating is up to date, find out when it went through its last accreditation review.

In a 1999, four-part series in the Boston Globe on hospital errors, reporter Larry Tye described the intense preparation undertaken by Westerly (Rhode Island) Hospital before their visit by JCAHO inspectors: Westerly staffers really might have been scared if they weren’t so thoroughly prepared. They’d been rehearsing for a year, with nearly 30 drills on everything from how to keep track of drugs to when to keep patients restrained. When you know the inspection was recent—or scheduled for the near future—you can figure that everyone in the hospital has been brushing up on their skills and paying special attention to safety procedures.

That story is as relevant today as it was over 20 years ago. Hospitals take JCAHO inspections very seriously because so much rides on the result of their visit.

Check with any hospital watchdog organizations in your area.

Your state or region should have a public or nonprofit watchdog organization that publishes failure-rate information about hospitals. If you’re not sure, call your state or local government citizen information line, or call your local Chamber of Commerce and ask for information about either government or private organizations that maintain track records on hospital performance.

For example, in Cleveland, Ohio, hospitals are required to publish their failure rates for certain procedures. In Massachusetts, both the Department of Public Health and the private Massachusetts Coalition for the Prevention of Medical Errors are involved in recordkeeping of medical errors. With a few telephone calls—or possibly by surfing through cyberspace—you should be able to find out who compiles such information in your own state.

A particularly useful website for patients, no matter which state they live in, is the one maintained by the Public Citizen Health Research Group at www.citizen.org/hrg/, which, among other things, has a tab for Health Care that proclaims Health care in the US leaves too many people out, costs too much and doesn’t meet acceptable standards of quality . . . Public Citizen advocates Medicare for All, stronger oversight of dangerous doctors and safe clinical trials. Although I have a different view about the feasibility of Medicare for All, this organization can help you advocate for yourself on many aspects of healthcare and, for that reason, I mention them here as a resource.

Check U.S. News & World Report’s Hospital Ratings issue.

This special issue of the weekly news magazine is published once a year. The various regional editions of the magazine include a Best in Your Area feature. But you don’t need to wait for the newsstand issue to appear. You can check the magazine’s website to see the rankings at https://health.usnews.com/best-hospitals/rankings.

Hospitals are ranked for each of the 16 major specialties and 9 procedures and conditions (including cancer, digestive disorders, otolaryngology, geriatrics, gynecology, heart, hormonal disorders, kidney/nephrology, neurology and neurosurgery, orthopedics, respiratory disorders, rheumatology, and urology, plus shorter, less detailed listings on hospital treatment of eye disease, psychiatry, pediatrics, and rehabilitation). The magazine and its website explain the many factors that go into compiling a hospital’s score. Among these are the following: reputational score, the percentage of physicians who identified the hospital in response to the U.S. News & World Report survey question; mortality ratio, a comparison of the actual-to-expected deaths of Medicare patients from admission through discharge in a 3-year period; technology services, a list of key technological services that the most advanced hospitals are expected to provide; and the ratio of registered nurses to beds.

Because of the comprehensiveness of its survey and the sound methods used to create the index and rankings, the U.S. News & World Report rankings are generally taken by the medical community to be a dependable guide for patients to use in making their hospital choice.

Understand your choices of different types of hospitals.

There’s more to hospital choice than finding out which has the best success rate for this or that procedure. You also have personal, religious, family, and employment considerations. Let’s say you’re having routine hernia surgery. You don’t need an ultra-high-tech center. Once you’ve chosen a surgeon you trust, who has a good track record, you probably don’t have to worry much about the hospital’s ranking on a national level. Just be sure you’re choosing only from among accredited places and that there are no ongoing scandals.

Once you’ve done that, you can start looking at the other non-medical issues that play a role in your comfort and emotional health. For example, will you be able to be visited by your children during the day? Will the food conform to your religious requirements? Is the hospital close to your home?

To answer these questions, you have to know something about the different types of hospitals and the advantages and disadvantages of each. To review:

There are general hospitals, which are usually located in a large urban or regional center and are able to provide the broadest range of services.

There are community hospitals, which tend to be smaller, sometimes lacking the most advanced care. They may or may not be part of a university program, so there might be no medical students to bother you, but also no teaching doctors in attendance there—and teaching doctors tend to be highly regarded in their field. Eager and thorough medical students tend to pore over the details of their patients’ cases, looking to learn something new and interesting, which older doctors sometimes don’t have the time or energy for.

There are teaching hospitals, which do assign medical students, interns, residents, and fellows to cases—and while the students won’t have the sure, skilled touch of a long-experienced doctor or nurse, they will have boundless enthusiasm and curiosity and may study your case with an interest in the details that the older personnel no longer have. Interns, residents, and fellows in these hospitals will be assisting your attending physician in many aspects of your care.

There are specialized hospitals that only work with a certain type of patient; for example: pediatric hospitals that just treat children; veterans hospitals just for former members of the military; maternity hospitals that are only for the pregnant; or women’s hospitals that deal with the full range of women’s health problems. There are also orthopedic hospitals, coronary care hospitals, cancer treatment centers, rehabilitation hospitals, long-term care facilities, and an array of others grouped by specialty, either in freestanding facilities or as a separate building of a larger hospital center.

There are hospitals affiliated with religious organizations, which can provide clergy members to visit and comfort you and help you observe the rituals of your faith during your stay. But there may be restrictions on medical procedures that conflict with the teachings of that faith: For example, a Catholic hospital will not perform an abortion, except to save the life of the mother. Religiously affiliated hospitals may have their own rules that supersede a patient’s do not resuscitate order. You may be required to undergo heroic measures to keep yourself alive. (For more discussion about this issue, see the sections on Advance Health Care Directives in Chapter 5, Taking Care of Business.)

Keep in mind that these categories often overlap. Take, for example, Georgetown University Hospital in Washington, D.C. It belongs in four different categories: (1) It’s a large, general hospital serving the greater Washington metropolitan area. (2) It contains within it a specialized hospital, the Vincent Lombardi Cancer Center. (3) It’s a teaching hospital with faculty and students from the Georgetown University Medical School. (4) It’s religiously affiliated with the Roman Catholic Church.

The following table lists the hospital types I’ve mentioned and outlines some of the advantages and disadvantages of each. Of course, this list is far from comprehensive. You may want to compare my categorization to that of the JAMA article quoted earlier. Both are intended to give you an overview of the main hospital types. To get specific answers about any particular hospital, see the tip on taking a hospital tour, if you’re inclined to spend the time and effort on that.

Go on a hospital tour.

This is a routine thing for pregnant women to do when choosing a hospital for labor and delivery, but you may not have known it might be an option for other types of patients as well. It’s rare that a hospital would turn down a request to tour at least some parts of their facilities—and I would be wary of any hospital that did. Of course, to protect patients’ privacy, you cannot go into any occupied rooms, but you certainly should expect to be shown an unoccupied room, the nurses’ station, the cafeteria, the lounge, various waiting rooms, and other public areas. To schedule your tour, visit the hospital website or call the public relations department of the hospital of interest to you, or call the general information line and ask for your call to be routed to the right department.

When taking your tour, bring along a small notebook and take notes. Pay attention to cleanliness, noise level, and level of activity (it may be busy—that’s fine—but it should not seem frenzied or chaotic). Look around at the rooms that are open to your view and take note of any that seem particularly nice (or any you’d want to avoid); you might be able to get a requested room if the hospital isn’t crowded during your stay. Ask questions about anything that strikes you as problematic. For example, if you see that one of the elevators is out of service, ask How long has it been broken, and when will it be fixed?

Your tour guide may not be able to answer all your questions on the spot, but if he or she is good at their job, they’ll promise to follow up by calling or writing to you with whatever information they have been unable to supply during your visit.

A well-conducted hospital tour can do a lot more than help you decide on which hospital to choose. When you have the chance to familiarize yourself with the place where you’ll be staying during your procedure and recovery, you can prepare yourself, in both practical and emotional terms, for the experience you can expect to have there.

Don’t judge a hospital by its name alone.

Don’t assume, for example, that a hospital with General in its name can’t provide specialized care. Many large general hospitals have specialized sub-units within them. Massachusetts General Hospital is an excellent example of a general hospital that is also a mecca for top specialists and a place where patients can find cutting-edge therapies.

Another mistake patients commonly make is to avoid religiously affiliated hospitals if they’re not a member of that religious group. New York Presbyterian happens to be one of the finest hospitals in the country for all types of patients—definitely not just Presbyterians. There are Jewish hospitals, Catholic hospitals, Mormon hospitals, Baptist hospitals, Methodist hospitals, hospitals of almost every faith you can name, but all share a commitment to heal the sick, of whatever faith. You might lean toward going to a hospital affiliated with your own faith for the comfort you get from seeing familiar clergy in the halls, but let that be just one among many factors influencing your choice.

If you’re in doubt as to what type of care a particular hospital can provide, don’t speculate, call the hospital’s administrative or public relations office and get factual answers to your specific questions.

Do choose a specialized hospital if you neatly fit the category of patient the hospital was designed to treat.

There’s no question in my mind that children, for example, are better off being treated in pediatric hospitals. When your child is seriously ill in