Tip of the Month
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Fast-growing development in health care: Walk-in clinics open 12 or more hours a day and located in shopping centers. They handle minor emergencies and routine medical complaints.
Advantages: The new clinics combine the after-hours availability of a hospital emergency room with the more pleasant atmosphere of a doctor's office. No appointment is needed. Waiting time is usually under 10 minutes. Costs are often only half of what a hospital emergency room would charge.
Disadvantages: Most won't file insurance forms. That's left to the patients. Some encourage excessive lab tests to pad profits. Many don't have the sophisticated equipment that hospitals do to handle more serious emergencies.
Note: If you use one of the clinics, be sure a record of the treatment is sent to your regular doctor.
Know Your Rights When Entering A Hospital: All the civilized ways of making life dignified and graceful disappear when people enter a hospital, just the time they need those things the most. Important: To know the courtesies to which you have a right when in a hospital. More important: Your legal rights as a patient. Specifically:
Considerate and respectful care. Examples: Being included in conversations about your case and the way doctors and other personnel carry on in your presence. Having curtains drawn around your bed when being examined. Not being awakened in the middle of the night to be given a sleeping pill. None are legal rights, but they are essential courtesies to insist upon. Recourse if these rights are violated:
Speak up assertively, or have a friend or relative do it for you. Or: Contact a patients' representative that many hospitals have as ombudsman for patients.
Where to find them: In the hospital admissions booklet issued to new patients. (It may be near the bedside telephone; if not, ask for a copy.)
All current information concerning diagnosis, treatment, and prognosis of your condition, in terms you can understand. (Legal right.)
Information from the physician to enable you (or the surrogate decision-maker if you are too ill) to give informed consent before the start of any procedure or treatment. This includes any medically significant alternatives to a treatment, if they exist. Consent must be given before you are sedated. You have the right to withdraw consent if you change your mind. If you change your mind about giving consent: Get the original consent form back and destroy it. (Legal right.)
The authority to refuse treatment if you are not convinced it is necessary. The right to a full explanation of the consequences if you do or if you don't have it. (Legal right.)
Privacy in all examinations and consultations pertaining to your case. Example: If you are in a teaching hospital and you object to six students watching while the doctor performs your examination, you can refuse permission for them to be there. If students try to examine or treat you against your wishes: Ask to see the head of the department and remind that person that the attending physician and the hospital (as well as the students) are liable for any unauthorized exam or treatment. If you have been led to believe that the person examining or treating you is a doctor, and you later discover the person is a student, you can bring suit for fraud or misrepresentation. (Legal right.)
Confidentiality. Information relating to your care and condition should be discussed only with those medically involved in it. Where confidentiality may be a problem: In large teaching institutions where cases are necessarily discussed at conferences. If there are special reasons for wanting strict confidentiality (concern for employment prospects or damage to career), be sure to tell the physician at the outset. (Legal right.)
If a hospital doesn't have facilities to treat you, expect it to arrange for your entry into a hospital that does. It can't just discharge you. (Legal right.)
If any part of your treatment is going to be medical experimentation, you must be advised beforehand. To protect yourself from experimentation without your consent: Look for any dramatic change in treatment that the doctor hasn't prepared you for. And ask questions. (Legal right.)
The medical information in your records. The actual papers belong to the hospital (or the doctor), but the patient has the legal right to the information in them. Ask to see the records if the hospital won't give them to you. If the hospital balks at letting you see records, check the state law requirements. In some states, a lawyer's help may be required to get access to records, while others allow patients direct access. Some state hospitals and all federal hospitals must provide patients access to records, under the Federal Privacy Act and the Freedom of Information Act. (Legal right.)
When your child is the patient: If you want to stay with the child and the hospital discourages or refuses it, get the doctor to write a note advising it. Most hospital authorities are unwilling to refuse doctors' orders. Argue that you can't give a fully informed consent (a legal right) to the child's treatment if you can't be with the child to monitor reactions and make the proper judgment. Be quietly insistent. There are solid practical and emotional reasons for staying with a small child in the hospital, unless it is medically unfeasible.
Before signing in: Appoint a surrogate decision-maker who will look out for your interests and deal with the hospital staff, and who must be consulted whenever there are questions and decisions to be made about the treatment. (That's particularly important should you not be in condition to make those decisions.) Examples: A spouse, parent, child, brother, sister, lover, friend. Be sure the doctor caring for you knows who that surrogate is. It should be someone who is capable of putting your interests and comfort above all else and is not afraid to demand action or question authority.
Specific suggestions for patients and their families:
Do not agree to any diagnostic tests without clearly understanding their purpose and necessity. Reason: Threat of malpractice suits has led many doctors (and hospitals) to practice "defensive medicine." They schedule every conceivable test when only a few are truly relevant. (If the same tests have recently been performed by your own doctor, try to substitute those.)
Check medical insurance before tests or hospital visit. It may be possible to take some tests as an outpatient. But many policies cover only those that are done in the hospital and within a specified period before admittance. Note: If admittance is postponed, you are liable. Also check coverage on things like private vs. semiprivate rooms (most are written for semiprivate) and private nursing (if coverage is skimpy, the family could take the day shift).
Avoid going into a hospital on Friday, if possible. Reason: Nothing significant is ever done on weekends. Often the staff is skimpy and any emergency occupies everyone. Weekend patients pay generously for two days of bed rest and poor service.
Upon admission, ask to see the "Patient's Bill of Rights." Most good hospitals now publish these as part of the preparatory material offered to all patients.
Find out what medication has been prescribed (doctor should explain), and what it looks like (mistakes can occur). Also: How often the medication should be taken (again, watch out for errors). And what it is intended to do (including possible side effects). These are safety measures that will also make it easier to understand charges that appear on your bill.
If specialists are called in, ask why they are needed and what their credentials are. Also determine if there is an alternative specialist at the hospital in case the first is not satisfactory to the patient.
If surgery is being considered, get a second opinion. Blue Cross and other insurance plans not only pay for this, but encourage it as a good way to avoid unnecessary surgery. If it's a tie, get a third opinion.
Question any of the items on the hospital bill that you do not understand. Patients and their families are entitled to an explanation of all the charges, whether or not they are covered by insurance. The financial department of the hospital can explain what typically is or isn't covered by Medicare, Medicaid, Blue Cross, and other insurance plans. They will also clarify the terms under which payment is expected from the patient.
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