The eight essential questions you should always ask your doctor in hospital
Worse, you aren't awaiting an exciting business trip or relaxing holiday, but are living with the anxiety that ill-health, an operation or medical investigations can bring. Often away from loved ones and immediate familiar support, time in hospital can be scary and isolating.
On the other side of the curtain, I recall with embarrassment my first ward round as a clueless medical student. It's a world of jargon, speed and uncertainty. Just getting to grips with the hospital hierarchy takes some time – even for a young doctor. But this isn't about me. It is about those on the receiving end of inpatient medical care. Those confined to a mattress designed more for practicality than comfort; those looking for answers.
The following are essential questions that can ease the hospital experience, whether you find yourself, or a loved one, admitted.
What is really wrong with me?
Sometimes this is clear from the outset and a hospital stay is simply providing the treatment. On other occasions there is a more frustrating hunt for a diagnosis, using a combination of tests and investigations to inform the team. I once admitted a patient overnight with severe chest pain and arranged a barrage of cardiac investigations. It was not until the consultant ward round the following morning that the tell-tale blistering rash of shingles appeared across her chest.
If you are unclear as to what the suspected diagnosis is then simply ask. The clinicians involved should have a working list of potential diagnoses, even if the final answer has yet to be reached. Sometimes time works well as a diagnostic tool.
Why am I being constantly asked the same questions by different medics?
One of the greatest frustrations patients report is the constant checking and clarifying of information during a hospital stay. Why have you come? Some are so fed up with being asked this question that they begin to wonder why they ever bothered. A&E receptionist, triage nurse, A&E doctor, senior A&E doctor, admitting junior doctor, speciality doctor, inpatient consultant, allied health professionals, the list goes on. It is not unusual to repeat your story 10 times over. Is this inefficiency or a system designed to provide so many safety-nets that hopefully little falls through?
The truth is that your story matters. What you say and how you describe it – the history of the presenting complaint – is still the greatest diagnostic tool that we have. Take a pain in your chest for example: does the pain worsen with exercise and exertion? Yes. Can you press your chest wall and reproduce that pain? A 'yes' here might mean we can discharge you home after some simple safety checks with pain relief for musculoskeletal chest pain – a chest sprain, if you will. But a 'no' could point to a cardiac cause and require a series of more invasive inpatient investigations. Think of the tedious repetition therefore, as vital clarification rather than onerous interrogation.
Medical decisions are based on a clinician's internal algorithm, not dissimilar to those flow charts you might have used at primary school to identify an insect. A badly placed 'yes' can lead to an incorrect diagnosis. The chart says caterpillar when, in reality, you're a bluebottle. Don't be baffled by the questions; instead, try to clarify in your own mind the exact events that have brought you here. It's not always easy.
How long will I be in here for?
The time you stay will vary drastically depending upon the diagnosis, the investigations required and your speed of recovery. Bed availability on specialist units, space in the scanner and emergency cases in the operating theatre can all extend hospital stays for logistical reasons. The most urgent cases usually take priority.
What is going to happen today?
Once admitted, the ward round, which usually happens each morning, is the key interaction of the day for medical updates and progress. A gaggle of enthusiastic healthcare professionals surround the bed, usually headed by the most senior doctor available from the team. This may be the consultant, but could also be a registrar or other junior doctor depending on staff commitments. Nursing staff and other allied health professionals often join the round too. Results are reviewed, medicines prescribed and that all-important plan for further management is created.
Now is your chance for questions. The team of onlookers can feel somewhat intimidating, but do not be afraid. By involving yourself in your care you will be empowered to more clearly understand the path that lies ahead.
For those unable to fully engage, it may be possible for an advocate to be present at the ward round or to arrange a meeting later in the day with a doctor from the team. Use your time wisely. Hours of boredom will no doubt ensue during your stay, so make a list of questions or concerns. This can prevent the inevitable stage fright when the team finally arrives at your bedside. Get timelines for further investigations or procedures and the working diagnosis.
What tests am I having and why?
Blood-pressure tests, heart-rate tests, oxygen-level tests. Tests, tests and then yet more tests. They are all part of the 'early warning scores' – a way for hospitals to identify patients who may need more immediate medical attention, which are calculated from your vital signs to determine how stable you currently are and therefore how frequently your 'observations' need to be taken.
A quieter night is on the cards for those steady and stable, with closer monitoring for those more clinically unwell. Infuriating as the visits can be, do not underestimate the importance of the opportunity for a brief catch-up with the nursing team to discuss medical issues, request pain relief or simply share a joke or story. Keeping morale high helps everyone on both sides.
Those staying a little longer will become overly familiar with the daily blood taking visit from the Dracula-inspired phlebotomist. These tests can provide vital clinical information for your team, but are not always essential every day. Sometimes the default position is simply to test, so if the daily ritual is becoming burdensome, check in with your doctors to establish whether such regular testing is essential. Perhaps the Count could have a day off?
If I have more questions, who can I talk to?
If you are uncertain or concerned about any aspect, start by discussing matters with the nurse looking after you. If they are unable to clarify things, then request a discussion with one of the doctors from the team.
You will have a named consultant responsible for your overall admission to whom you should be able to speak should the need arise. For matters relating to logistics and your experience on an inpatient ward, the Ward Manager is an excellent first port of call.
If you find that your concerns are still not being addressed, you can contact the Patient Advice and Liaison Service (PALS) team at the hospital, who can provide further support and information.
How can I get out of here?
Once a diagnosis has been reached and treatment delivered, the attention of most patients quickly turns to the quickest escape route. This can be frustratingly slow. Physiotherapists must ensure that you are safely able to mobilise. The all important 'stairs assessment', whilst sounding like a legal requirement from Building Control, is designed to ensure that those who have to negotiate stairs in their home environment can do so with minimal risk of falls.
Occupational therapists may work with you to help optimise your home environment, ensuring that you can manage daily tasks such as cooking, washing and putting the kettle on. For those in need of more support, social workers may be involved in arranging a package of care to support you at home, or to help find a placement in a residential or nursing home.
When the great escape seems tantalisingly close, the final hurdle, which I can liken only to the inevitable wait at the airport baggage-reclaim carousel, is for the pharmacist to deliver any medications required for discharge. Stringent checks and overstretched teams mean this can make even the most bureaucratic customs official seem efficient. If your ultimate exit is reliant upon hospital transport, I recommend a good book and patience of a saint.
What happens after discharge?
Accompanying you out of the door should be a 'Discharge Summary'. A copy of this will be sent to your GP for information and further action where required. It is well worth taking a photo of this in case the important document disappears in the baggage-reclaim chaos. This document should detail the events of your stay but, crucially, also any follow-up plans, including details of upcoming outpatient investigations and appointments.
Any prescribed medicines are also listed on this document with instructions on when and how they should be taken, so keep this at hand to accompany that reclaimed baggage from the pharmacy team.
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