47 Secrets Hospitals Don’t Want to Tell You (But Every Patient Should Know)
No one looks forward to a health crisis, but our insights and tips will help you get better medical care, cut hospital bill costs, and get out of the hospital alive.
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Pick a teaching hospital
“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.” —Evan Levine, MD, cardiologist with ProHealth Physicians Cardiology in Danbury, CT. Check to see if you know the difference between an MD and a DO.
Beware freestanding ERs
“Those freestanding ERs popping up all over? They typically don’t have anywhere near the resources of hospital ERs, yet they cost just as much. Go there for small bumps and bruises. For something serious (chest pain, a badly broken bone), get to a trauma center where specialists and surgeons work.” —James Pinckney, MD, an ER doctor, founder of Diamond Physicians in Dallas, Texas. Check out these other 50 secrets an ER staff won’t tell you.
Shop around for rehab
“If you’re being released for rehab, shop around for a place that has experience with your condition. We found that rehab facilities that handle more than two dozen hip fractures a year were more than twice as likely to successfully discharge seniors within a month as less experienced facilities were.” —Pedro Gozalo, PhD, professor in health services policy and practice at Brown University in Providence, Rhode Island
“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, remotes, doorknobs, phones, call buttons, and toilet flush levers. Wash your hands before you eat.” —Karen Curtiss, patient safety advocate and author of Safe & Sound in the Hospital: Must-Have Checklists and Tools for Your Loved One’s Care. Here are 14 more tips to avoid getting sick.
Join the conversation
“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.
Don’t be a distraction
“Don’t interrupt the nurse when he’s preparing your medications. One study found that the more times you distract him, the greater the likelihood of error. [Each interruption was linked to a 12 percent increase in errors.]” —Sally Rafie, PharmD, a hospital pharmacist with the UC San Diego Health System. Check out these other 49 secrets your pharmacist won’t tell you.
Ask what your doctor will be doing
“The surgeon who performed the best in our complication rate analysis said he and his partner drape their patients, do the whole operation, and close the incision themselves. He said, ‘I just know nobody is going to do it as carefully as I’m going to.’ Check whether your doctor will be doing your entire procedure and whether she will do your follow-up care.” —Marshall Allen, a reporter who covers patient safety for ProPublica, a nonprofit news outlet
Nurses are overwhelmed
“Hospitals often force nurses to handle more patients than they should—even though studies show if your nurse is responsible for fewer patients, they have better outcomes. California is the only state with hospital-wide minimum nurse-patient staffing ratios. Researcher Linda Aiken at the University of Pennsylvania found that each extra patient a nurse has above an established nurse-patient ratio made it 7 percent more likely that one of those patients would die.” —Deborah Burger, RN, copresident of National Nurses United. Here are 50 more secrets nurses want you to know.
Administrators make big bucks
“Top administrators at U.S. hospitals are paid extremely well. CEOs make $400,000 to $500,000 a year, not including benefits like stock options. Administrative expenses eat up as much as 25 percent of total hospital expenses we pay for—much higher than in other countries.” —Cathy Schoen, Senior Scholar in Residence at the New York Academy of Medicine.
Doctors are incentivized to overtreat
“I hear from surgeons all the time whose bosses are basically beating on them to do more operations. While some hospital systems have moved to flat salaries, most still provide bonuses for more volume. Doctors have an incentive for over-treatment.” —Marty Makary, MD, MPH, a surgeon at Johns Hopkins Medicine in Baltimore, MD, and the author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. Be extra careful when it comes to these 14 risky medical treatments that don’t always work.
You may unknowingly pay for out-of-network care
“Even if you’re careful to choose a hospital and a surgeon that are in-network, there’s no guarantee that everyone involved in your care at the hospital is also in-network. The radiologist, anesthesiologist, pathologist, and even the assistant surgeon could be out of network, and—surprise!—you’ll be billed at a much higher rate. [Some states, including New York and California, now have laws to prevent this from happening.]” —Cathy Schoen
Ask if you’ll be admitted
“You can stay overnight in the hospital but never officially be ‘admitted.’ Instead, the hospital can say you are there ‘under observation.’ That can be tricky for seniors because if they’re then sent to a nursing home for rehab, Medicare won’t pay for it unless they were actually admitted. Always ask whether you’re admitted.” —Deborah Burger, RN. Plus, watch for these 10 signs a hospital wants to discharge you too early.
Specialists quietly pad your bill
Physicians may “call in an abundance of consults to help them take care of the patient. If those specialists check on you every day, your bill is being padded and padded. Ask whether those daily visits are necessary.” —Evan Levine, MD. Don’t miss these other 18 secrets health insurance companies don’t want you to know.
Ask how to recover faster
“Since each day in the hospital costs $4,293 on average, one of the best ways to cut costs is to get out sooner. Find out what criteria you need to meet to be discharged, and then get motivated, whether it’s moving from the bed to a chair or walking two laps around the hospital floor.” —James Pinckney, MD, founder and CEO of Diamond Physicians in Dallas, TX
Bring your own meds
“It’s a lot cheaper—and usually OK—to bring your own medicines from home, but the hospital pharmacy will have to check them to verify they are what the bottle says. Just ask your doctor to write the order.” —Michele Curtis, MD, an ob-gyn in Houston, Texas. Don’t miss these 10 signs you’re taking too many prescriptions.
Check, check, check your bill
“Eight out of ten hospital bills we see contain an error, so check your bill carefully. You may identify a drug you didn’t take. Or you know that you discontinued a treatment on Tuesday, but you were charged for Wednesday. The number on the bill is only a starting point. Try to negotiate for 35 to 50 percent off the charges.” —Pat Palmer, medical billing advocate and cofounder of MedExpense Solutions in Roanoke, VA.
Understand your evaluation
Fifteen to 30 percent of everything that’s done—tests, medications, and procedures—is redundant. “It’s partly because of patient demand; it’s partly to prevent malpractice. When your doctor orders a test, ask why, what he expects to learn, and how your care will change if you don’t have it.” —Marty Makary, MD.
Hospitals are becoming more like hotels
“Hospitals worry about losing revenue to retail clinics, urgent-care centers, and private surgery centers. To attract patients, they try to appear like hotels. They have waterfalls, pianos, and big windows. Instead of hiring people with backgrounds in health care, they’re bringing in people with experience in retail and five-star hotels.” —Bill Balderaz, a health-care IT consultant in Columbus, OH. Check out these other 12 insider tips for improving your hospital stay.
We’ve seen it ALL
“We see crazy things. I had a patient run buck naked into the ER waiting room. A patient asked me out while I was holding a basin, catching his vomit. We pull bugs out of people’s ears regularly.” —An ER nurse in Dallas, Texas. Don’t miss these other 11 crazy stories from ER staff.
Hospitals cut chaplains to save money
“Spiritual care is not a profitable area for hospitals, so it gets cut. The vast majority don’t have enough chaplains, and some U.S. hospitals today don’t have chaplains at all.” —Rev. Eric J. Hall, president and CEO of the HealthCare Chaplaincy Network, a New York City-based nonprofit. You can invite your religious leader as a visitor during normal visiting times. Read these life lessons from chaplains and other people who spend time with the dying.
VIP patients can affect your care
“In many hospitals, VIP patients get special treatment. They may stay in special areas or have a VIP notation on their chart, which means that whenever their bell goes off, we are expected to make that patient’s request a priority, whether it’s ‘I need some water’ or ‘Can you get me some stamps?’ Hospitals don’t add more nurses; they just take away from the care everybody else gets.” —Deborah Burger, RN.
Surgeons multitask major operations
“Your surgeon may be doing someone else’s surgery at the same time as yours. We’re talking about complex, long, highly skilled operations that are scheduled completely concurrently, so your surgeon is not present for half of yours or more. Many of us have been concerned about this for decades. Ask about it beforehand.” —Marty Makary, MD. Don’t miss these other 50 things your surgeon won’t tell you.
Electronic paperwork annoys us
“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, RN. When doctors are filling out by hand, find out why they have such bad handwriting.
Our priorities have changed
“Because Medicare has put more emphasis on the results of patient satisfaction surveys, hospitals are pushing us to emphasize customer service. It makes me worry we will do what we can to make people happy in place of what we should. To say that you need to focus on getting this person’s dinner right even though your other patient needs his chemo hung—that’s not right.” —Theresa Brown, RN, author of The Shift. Learn how to tell if you have a good (or bad) doctor.
Managed-care companies dominate our time
“The amount of time I spend on the phone talking to doctors working for the managed-care companies is, in my eyes, a complete waste of time. This morning, I spent 30 minutes explaining why I’m giving a patient a particular medicine. Those doctors don’t know who the patient is, yet I have to persuade them to allow me to do what I believe is in the best interests of the patient.” —Sam Klagsbrun, MD, executive medical director of Four Winds Hospital in Katonah, NY. Find out how your state compares in national health care rankings.
Be detailed about your meds
“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, MD, a surgeon at the University of Utah in Salt Lake City and the author of What Doctors Cannot Tell You: Clarity, Confidence, and Uncertainty in Medicine.
Admitted? Log everything
“Keep a notebook. Write down your questions, log who’s coming into your room, and track conversations with different doctors. It’s easy to get confused and disoriented in the hospital. It will also be helpful once you get the bill to have a record of who saw you and when.” —Deborah Burger, RN. Plus, always ask these 10 questions before taking prescription medications.
Bring your own toiletries
“Hospital toiletries are awful. The lotion is watery. The bars of soap are so harsh that they dry out your skin. There is no conditioner. The toilet paper is not the softest. Come with your own.” —Michele Curtis, MD. Don’t forget to pack medications and use these 16 questions to save money on medication.
We lose money if you’re readmitted
“Hospitals used to not care about you once you were discharged. But under new rules, they face financial penalties if you are readmitted within 30 days. So now you may get a call from a nurse case manager a day or two after you’re discharged asking if you have any questions, checking if you got your prescription filled, and making sure you have transportation to your follow-up appointment.” —John W. Mitchell, former CEO of three hospitals. Check out these 10 doctor-approved tips for getting discharged faster.
We track your data—for you
“Some places use big data to improve patient satisfaction. We take all the information we have on you—age, ethnicity, health conditions, ZIP code, profession—and cross-reference it to find similar patients who have already filled out satisfaction surveys. Based on what we know about those patients, we try to figure out your preferences: how often you want nurses to assess you, how much time you like the doctor to spend with you, and what you may want in your room. We’ve seen a significant boost in patient satisfaction.” —Bill Balderaz. Learn these insider tips on finding the best doctor.
We can monitor you from a distance
“Hospitals try to lower the number of patients readmitted through remote patient monitoring. They may have you wear a monitor that tracks your vitals and alerts your team if they go out of range. They may ask you to download an app that reminds you to take your pill. If you don’t mark that you’ve taken it after a few reminders, a nurse calls.” —Bill Balderaz. Find out why doctors still use pagers.
Being transferred? Speak up
“If you go to a smaller hospital and it has to transfer you to a different medical center, demand that it ship you to the closest one that can handle your care. What’s happening is that community medical centers are sending patients instead to the big hospital that they’re affiliated with, even if it’s farther away. It happens even when a patient is bleeding to death or having a heart attack that needs emergency care.” —Evan Levine, MD.
Stay with your loved ones
“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 (many are eliminating them), ask if it will make an exception.” —Michele Curtis, MD. Just avoid these 10 things you should never do when visiting a hospital.
Hospital food could make you sick
“Don’t assume the food is what you should be eating. There’s no communication between dietary and pharmacy, and that can be a problem when you’re on certain meds. I’ve had patients on drugs for hypertension or heart failure (which raises potassium levels), and the hospital is delivering (potassium-rich) bananas and orange juice. Then their potassium goes sky high, and I have to stop the meds. Ask your doctor whether there are foods you should avoid.” —Evan Levine, MD.
Schedule surgery early in the week
On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other diagnostic services may be unavailable. If you’re having major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend. —Roy Benaroch, MD, a pediatrician at Pediatric Physicians in Roswell and Alpharetta, GA and the author of A Guide to Getting the Best Healthcare for Your Child. Don’t miss these 12 plastic surgery procedures your insurance might cover.
Go ahead, hydrate before surgery
“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 American Society of Anesthesiologists guidelines are more nuanced: no fried or fatty foods for eight hours before your surgery and no food at all for six hours. Clear liquids, including water, fruit juices without pulp, soda, Gatorade, and black coffee, may be consumed up to two hours beforehand.” —Cynthia Wong, MD, professor of anesthesia at the University of Iowa Healthcare in Iowa City, IA
Too much rest could impede recovery
“Get up and move. Walk the halls, walk to the cafeteria, 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.” —Roy Benaroch, MD.
Take notes, especially at discharge
“One study found that patients forget 40 percent to 80 percent of what doctors and nurses tell them, even if they’re nodding their heads. Have someone with you to take notes or tape-record what the doctor says on a smartphone. (Ask, ‘Do you mind if I tape-record this?’) The most critical time to record is at discharge when you receive crucial information about medications and next steps.” —Karen Curtiss. Hold on to your own money with these 11 tips for lowering your hospital bill.
Get your papers right away
“Get copies of your labs, 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. Even though I have a computer and the hospital has a computer, our computers don’t talk to each other.” —Roy Benaroch, MD. When you’re reading through, learn how to say these 35 medical words you always mispronounce and don’t mistake these 28 medical words you should never confuse.
Request a full night’s sleep
“If you’re feeling good and you are stable, ask your doctor whether you can sleep undisturbed between midnight and 6 a.m. I can write a note directing the nurses not to wake you up to check your vital signs.” —Michele Curtis, MD. Use these 13 tips from sleep doctors for an even deeper sleep.
Schedule your follow-up before you leave
“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 who will take care of you.” —Elizabeth Bradley, PhD, president of Vassar College in Poughkeepsie, NY. If it’s a primary care doctor, read these 12 tips for picking the best physician.
Try to be patient in the ER
“Emergency rooms used to have just curtains between the patients, so they could hear the chaos. As a result, I think they were a lot more understanding about delays. Now most hospitals have individual ER rooms that are very isolated. When patients get upset that it took me 20 minutes to come back to their room, I often wish I could tell them that I wasn’t sitting out there doing nothing. I was comforting someone who just lost a family member.” —An ER nurse in Texas. Try your hand at guessing what these weird ER terms mean.
We never forget devastating moments
“My worst moment ever was on New Year’s Eve in 2008, when the code-blue pager went off. A baby we had 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.” —James Pinckney, MD.
We know your treatment is overpriced
“One time, I ran into a patient I had performed a simple appendectomy on. He thanked me for saving his life, then told me it almost ruined him because he couldn’t pay the bill. Four hours in the hospital and they charged him $12,000, and that didn’t even include my fee. I showed his bill to some other doctors. We took out an ad in the newspaper demanding change.” —N. Hans Rechsteiner, MD, a general surgeon at Burnett Medical Center in Grantsburg, WI. These 10 hospital costs, for example, are ridiculously expensive.
- Evan Levine, MD, cardiologist with ProHealth Physicians Cardiology in Danbury, CT
- Pedro Gozalo, PhD, professor in health services policy and practice at Brown University in Providence, Rhode Island
- Karen Curtiss, patient safety advocate and author of Safe & Sound in the Hospital: Must-Have Checklists and Tools for Your Loved One's Care
- Nursing Management: “The secrets to successful nurse bedside shift report implementation and sustainability”
- Sally Rafie, PharmD, hospital pharmacist with the UC San Diego Health System
- Archives of Internal Medicine: “Association of interruptions with an increased risk and severity of medication administration errors.”
- Marshall Allen, reporter for ProPublica, a nonprofit news outlet.
- Deborah Burger, RN, co-president of National Nurses United.
- Lancet: “Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.”
- Cathy Schoen, Senior Scholar in Residence at the New York Academy of Medicine.
- Marty Makary, MD, MPH, surgeon at Johns Hopkins Medicine in Baltimore, MD, and the author of Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
- James Pinckney, MD, founder and CEO of Diamond Physicians in Dallas, TX
- Michele Curtis, MD, an ob-gyn in Houston, Texas
- Pat Palmer, medical billing advocate and cofounder of MedExpense Solutions in Roanoke, VA
- Bill Balderaz, a health-care IT consultant in Columbus, OH
- Karen Higgins, RN, member, National Nurses United
- John M. White, a hospital security consultant
- Rev. Eric J. Hall, president and CEO of the HealthCare Chaplaincy Network, a New York City-based nonprofit
- Alexandra Robbins, author of The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital
- Theresa Brown, RN, author of The Shift
- Sam Klagsbrun, MD, executive medical director of Four Winds Hospital in Katonah, NY
- Kevin B. Jones, MD, a surgeon at the University of Utah in Salt Lake City and the author of What Doctors Cannot Tell You: Clarity, Confidence, and Uncertainty in Medicine
- John W. Mitchell, former CEO of three hospitals
- Roy Benaroch, MD, a pediatrician at Pediatric Physicians in Roswell and Alpharetta, GA and the author of A Guide to Getting the Best Healthcare for Your Child
- Anesthesiology: “Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration.”
- Cynthia Wong, MD, professor of anesthesia at University of Iowa Healthcare in Iowa City, IA
- JAMA Internal Medicine: “In-hospital mobility and length of stay”
- Experimental Aging Research: “Remembering what the doctor said: organization and adults' memory for medical information.”
- Elizabeth Bradley, PhD, president of Vassar College in Poughkeepsie, NY
- Hans Rechsteiner, MD, a general surgeon at Burnett Medical Center in Grantsburg, WI