A Medical Consultation : You Won’t See ‘ER,’ but a New Book Tells What You Can Expect at a Hospital.
So here you are in a hospital bed, the very last place you want to be. Your toast is burnt, your backside’s drafty and you’re wondering what part of the bill will be yours.
You wish you knew the ropes--or the chief of staff.
To the rescue comes “Hospital Smarts” (Hearst Books), a just-published insider’s survival guide written by two physicians on staff at New York Hospital-Cornell Medical Center.
Dr. Theodore Tyberg, a cardiologist, and Dr. Kenneth Rothaus, a plastic and reconstructive surgeon, draw on 30 years of combined experience to clue patients in on exactly what to expect.
During a recent telephone interview from their New York offices, they knocked the Dodgers, got sensitive about their accents (“You think all New Yorkers sound alike?”), and offered their advice for patients-to-be.
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Question: First, the obvious: Have either of you ever been hospitalized?
Tyberg: Neither of us has been. We’re healthy guys. But we basically live there.
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Q: And, in the process, learned the ropes. So, let’s start with the admitting office, which can unnerve a lot of patients. Any tips on maneuvering this paperwork jungle?
Rothaus: Get everything approved ahead of time. A lot of insurance companies require approvals. Make sure you do the [pre-admission] testing ahead of time. Most hospitals require tests done 10 to 14 days ahead. If you’re out of town and arrive the night before to take tests, you’ll have a hassle.
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Q: Once admitted, it seems the language turns medical-ese. Can you translate?
Rothaus: During rounds, the intern or resident might say, “This is the third POD.” That’s postoperative day. “The patient spiked last night” means the patient ran a very high fever.
Tyberg: “The patient detuned” means you were doing fine and then all of a sudden you had a catastrophic medical or surgical problem, somewhat unexpected. We have to “tune you up.”
Rothaus: A lot of the language will have to do with tests. You may hear “CBC,” which means complete blood count. “Change their lines” means your intravenous lines need to be changed. That happens usually every 48 hours.
You might hear a student or resident say, “She has a negative Homans’.” That’s Homans’ sign, and that means they checked the legs for phlebitis or clots.
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Q: Your book talks about hospital fashions and how attire reflects medical pecking order.
Tyberg: In general, the shorter the white coat, the lower the level. Medical students and interns wear short coats, attending physicians wear longer coats. But every hospital is a little different.
When you’re a medical student or an intern, you think it’s sexy to wear a scrub suit and hang a stethoscope around your neck.
Rothaus: Outside the operating room, my kids are the only ones who wear my scrubs now.
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Q: During a pre-surgical consultation, what are the most crucial questions? And the most overlooked?
Rothaus: I think the most crucial are, “What are the indications for this procedure, and what are the risks and results?” “Why are you suggesting this procedure?”
The most overlooked is, “What happens if I don’t have surgery?”
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Q: Any advice on coping with operating room anxiety?
Rothaus: The anxiety is before [the ride to the OR]. The night before, if you have trouble sleeping, ask your surgeon for a sleeping pill. Or [if not yet admitted], go out for a nice dinner and movie.
Bring something to read. If you knit, bring that. Bring something you don’t mind losing. Keep it with you until the minute you leave the holding area.
Or, buy two copies of a paperback. Give one copy to a nurse before you go into the OR. Keep the other copy in your room or your bag, and you can pick up where you left off.
Tyberg: Realistically, there’s almost no way your anxiety is going to go away before surgery. Everybody’s scared. You just want to stay occupied.
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Q: Recently, so-called misadventures at hospitals--in which the wrong procedure is performed or the wrong limb amputated--have unnerved patients. How can a patient minimize this risk?
Rothaus: There are a lot of safeguards. You are asked [what the proper operation is] by the nurse in the holding area, the nurse in the OR, the anesthesiologist. Go over it with your surgeon. Make sure the consent describes exactly the procedure you are going to have.
Tyberg: Much more common [than surgical mistakes] is for a patient to get the wrong medicine. Never put anything in your body . . . unless you know what you are getting.
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Q: Suppose, as a patient, you arrive via the emergency entrance. On TV, George Clooney meets you at the door. But what’s the real-life scenario?
Tyberg: If you are in a true emergency, then George Clooney will meet you. But 99% of the time, you will meet a triage nurse. That person will assess how sick you are and in what order you will be seen.
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Q: What about that long-standing tradition of morning rounds, when everyone on the floor seems to be in your room, breathing down your neck? Can a patient just say no?
Tyberg: Yes, a patient can, but it’s a big mistake. Two heads are better than one. What morning rounds do is familiarize everyone on the health team with your medical problems. It’s a good safety factor for you.
The intern who admits you is there for that whole first day and then goes home. In the middle of that night someone else is your primary house staff doctor. If that person met you on morning rounds, he or she is familiar with your case.
Rothaus: If you’re having some sort of exam which you find embarrassing, and there are a dozen people around, you certainly can say, “Can we close the curtain?” It’s difficult for a dozen people to remain inside the curtain.
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Q: No conversation about hospitals would be complete without a mention of food. Your tips, please, on maximizing the hospital dining experience?
Tyberg: Order from your local Chinese restaurant.
Rothaus: If you don’t have any restrictions, have someone bring in food from the outside. If you’re really unhappy with the food and they’re not going to let you bring it in from the outside, ask the dietitian to come by. She’ll try to help you.
