According to a New England Journal of Medicine study, nearly one-fifth of Medicare patients discharged from a hospital—about 2.6 million seniors a year—develop an acute medical problem within the first thirty days that will necessitate another hospitalization.
Called post-hospital syndrome, these problems affect patients of all ages and commonly include heart failure, pneumonia, bronchitis and emphysema, infection, gastrointestinal conditions, mental illness, metabolic disorders, and trauma. The best way to guard against post-hospital syndrome is to get a full briefing before you leave the hospital. Unfortunately, some patients aren’t even given discharge instructions—a recipe for medical disaster. Insist upon them. Here are your must-ask questions.
1. Has my diagnosis changed? You went in to have, say, a cancerous lump or tumor removed, and there was a hypothesis about what it would be. Now that it’s out, ask, What was it? Was our theory correct? We thought I had Stage II lung cancer, but is it really a Stage III? Has it metastasized? Find out more about your condition.
2. What was the ultimate treatment? What did the doctors do while they were operating on you? Was it a partial or a full removal of the organ? Were there any surprises or complications? Be sure to ask for a copy of your surgical report, too. Every surgery has one and you may need it for myriad reasons—not least of which is that it will become an important part of your medical history.
3. What should I expect during my recovery? Find out how to navigate the days and weeks ahead. Ask, What are the symptoms I need to watch for? What’s urgent to attend to, and what’s something I can alert you to at our next visit? For example, if you have a fever, let your physician know immediately, because it means you may have an infection. But what about a rash? Shortness of breath? Particular kinds of pain? Ask, What level of pain should I expect? And is there a different sort—sensation, location, duration—that would be of concern? If you’re feeling a sharp burning in your abdomen, it’s important to know whether (a) that’s a normal effect of your surgery, (b) this requires a call to your physician during business hours, or (c) this is a “911—let’s go!” kind of problem.
4. What sort of equipment will I need? The transition from hospital to home requires logistical organization, which is why so many patients end up feeling unprepared. Just ask, What do we need at home? You may need a wheelchair for a few days, or a walker. If you’ve had a hip replacement, you may need a raised toilet seat, because you won’t be able to sit that low. Are there stairs leading to your home or apartment? Is there a way for you to get up them?
5. What activities should I avoid, and what do I need to do? Even after something as mundane as bunion surgery, you have to spend the first couple of days in bed with your foot elevated. If you’ve had abdominal surgery, there will be restrictions about lifting and bending. This is the time when you are most vulnerable to re-injuries and falls, so ask, What are the limitations on my activities? When can I drive? When is it safe for me to carry a bag of groceries? Conversely, what are your obligatory activities? Maybe it’s icing the site for twenty minutes, six times a day. Maybe it’s using large rubber bands every night and morning to restore full range of motion in your repaired joints. Find out.
6. Are there dietary restrictions I need to follow? Ask, Are there special foods we should buy on the way home? Are there salt, sugar, or alcohol limitations I must heed? What will happen if I get it wrong?
7. How do I properly care for wounds and incision sites? Find out how often bandages need to be changed. Also: Are there colors or odors to be concerned about? What kind of bandages do I need? Can I shower? Can I go in the sun?
8. How do I reach medical personnel? Because complications don’t happen on a schedule, you need to know how you can get in touch, 24/7, for immediate help if something happens. This question is essential. Get a phone number and a name to ask for.
9. When’s my next appointment? Ask, When should I come back to see you or my attending physician? What should I bring with me?
10. What’s my medication schedule? This may be one of the most important pieces of information you receive at discharge. If you need to take medications, what are they? Get both generic and brand names. What are the dosages? What’s the timing? How long do I take them for? Get your medication schedule in writing so it can be charted on a sheet of paper, with you or someone else making a check mark every time you swallow a pill. When you’re in a post-hospital fog and time is amorphous, this will become essential.
For more guidance on staying safe in the hospital, read Chapter 12, "Step 4—Coordination," in The Patient's Playbook.