Be Your Own Health Care Advocate: Part 2

Last week, we shared a checklist for you to take to your next doctor’s appointment.

But what if you land in the hospital? Do you know the right questions to ask? You’ll want to take our checklist from last week and also include questions specific to your hospital stay.

Remember, the only person who will really take care of you… is you.

Today, we’re adding to our checklist. Read it over and be sure to share it with your loved ones… because we don’t always get advance notice we’re heading to the hospital. In case of emergency, you’ll want a contact who knows your wishes and can ask these questions on your behalf.

Your Hospital Checklist

1. If you have advance notice, research your hospital first. I’ve encouraged my readers for years to find the best hospitals near them for certain types of care they may need. You want to know the best centers for cancer, heart, gastrointestinal, joint surgery, and more.

I recommend looking at the rankings from U.S. News & World Report. It ranks hospitals based on data like number of patients, survival rates, infection rates, and the nursing staff. See its latest ratings right here.

It’s also important to see which ones are in-network for you – going to an out-of-network hospital can rack up thousands of dollars in hospital bills. Be sure to check your insurance provider’s website to see its list of in-network providers. You can see Medicare’s list here.

2. Ask if your surgery or procedure can wait. If you’re looking at a teaching hospital, it’s best to avoid it during the summer months.

Doctors in training, referred to as “residents,” start training every year on July 1. So in June, the senior residents are about to leave for the real world and aren’t focused on caring for you… They are thinking about getting out of there, finding real jobs, and starting to pay down their six-figure debt.

The new doctors coming in on July 1 just graduated from medical school. Most can’t yet find their way out of a paper bag.

But worse… the hospital’s senior doctors, called “attendings,” who are supposed to supervise the new kids, are taking summer vacations. Most let the senior residents run the show.

The good news is that the problem is temporary.

Once September hits, the new doctors have a few months of experience under their belts… The attendings are back at work and supervising again… And the hospital is as safe as it gets.

3. Research your doctor, too. The right doctor can mean the difference between life and death. Courts file about 85,000 lawsuits for malpractice every year in the U.S. But according to Stanford University, the worst 1% of surgeons are responsible for nearly a third of all malpractice claims.

As I’ve advised before, ask your surgeon for a printout of their statistics. They should keep them on a computer… If not, run out of the office. In addition, check their status with the American Board of Medical Specialties. Your doctor should be up to date on their exams and certified in surgery. You can find that right here.

You can also search by state for criminal convictions and malpractice claims for your surgeon. Go here to learn more.

4. Whether you go for a planned visit or in an emergency, there’s one important question you must ask. Am I an inpatient?

If you stay overnight at the hospital, your doctor may “keep you for observation” rather than admitting you as an inpatient. This allows them to collect far more from Medicare Part B. For instance, any medications you receive, you’ll have to pay for, instead of Medicare covering them. Once you’re an inpatient, you’re covered under Part A (hospitalization), and the hospital collects far less.

Worse, you could get stuck with thousands of dollars in medical bills because of it. And if you need any sort of nursing care after you leave, you won’t qualify for Medicare coverage unless you’ve been an inpatient for at least three days.

So after one night in the hospital, make sure to ask your doctor if you are an inpatient. If not, get it in writing that you are there under “observation status.” And argue that if your care is medically necessary, they need to admit you. This can be a difficult argument… but try enlisting the help of the hospital’s discharge planner if needed.

5. Make sure everyone washes their hands. Don’t worry about coming off as too demanding. Vigilance is extremely important, and you need to remain vigilant about folks washing their hands when entering your hospital room.

Similarly, if you have any concerns about cleanliness… ask. It’s always better to be overcautious than risk infection.

6. Go over discharge plans. Take the time to make sure you review your discharge plan and ask lots of questions. You’ll want to have someone present with you as well, in case you’re on medications and may not remember everything discussed.

Take notes and ask if there’s a number to call should you have any issues when you get home. You may need to ask your doctor if he has an on-call service.

7. Finally, take the time today to write out your final wishes. Let’s say the worst happens… You’re in an accident or have a sudden medical emergency and can’t make your own decisions for your health. Who do you trust to make those calls for you? You can choose anyone… a spouse, significant other, sibling, parent, or close friend. Make sure it’s someone you trust and who knows what kind of care you would want.

Name them as your health care proxy or durable medical power of attorney (these are the same thing). Then take it another step and give them your wishes written out for end-of-life care.

I’m talking about living wills and advance directives. The names vary by state, but it’s essentially a legal form outlining what you want done to keep you alive. Things like feeding tubes, cardiac resuscitation, etc. Having this laid out ahead of time will make decisions easier for the person you choose to look after your health when you can’t.

What We’re Reading…

Here’s to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
April 7, 2020