This book, written by a lawyer and a doctor explains to everyday readers ways in which they can avoid death and injury caused by medical mistakes. It may be shocking to learn that preventable errors by doctor and hospital personnel are a leading cause of death and injury in the United States—perhaps even exceeding the annual deaths caused by heart disease and cancer. But avoiding these mistakes is possible, and the rules found in this book will arm readers against the careless errors that lead to such deaths and injuries.

From hospitals to doctors’ offices, medical professionals are overwhelmed, overtired, even overworked and mistakes are sometimes unavoidable even with the best safety measures in place. A resident at the end of a 36-hour on-call stint may forget to wash her hands before performing a surgical procedure. A chart may be mismarked. Medications may be inaccurately listed. Test results may be inaccurately interpreted. But patients are in a position to help themselves and their medical caregivers to avoid these mistakes by taking more active and attentive part in their own healthcare. By being aware of the most common errors, patients can look for ways to ask questions, review information, even examine test results with a critical eye toward their own health and specific situations. Robert Fox and Chris Landon show them how.

Acknowledgments

Introduction

The Problem: Too Many Deaths

What Patients Can Do—Act!

Preamble to the Rules



Chapter 1: General Rules: Rules 1–32

Rule 1. Select (or Change to) a Competent Doctor

Rule 2. Use State Medical Board Websites to Verify the Credentials of Your Doctor

Rule 3. Don’t Hesitate to Ask Questions That Can Help Your Doctor Evaluate Your Medical Care and Protect Your Health

Rule 4. Be Courteous and Considerate to Your Doctor and All Other Medical Office Personnel

Rule 5. If You Have Doubts about Your Doctor’s Advice concerning Diagnosis or Treatment, Don’t Hesitate to Speak Up and Ask Questions

Rule 6. Insist That Your Doctor Tell You the Diagnosis Before You Accept Treatment

Rule 7. Be Persistent, Particularly If You’ve Been Told There Is Nothing Wrong, but You Know Something Is Wrong

Rule 8. Obtain an Independent Second Opinion

Rule 9. Be Careful Before You Accept Experimental or Unproven Medication or Treatment

Rule 10. Consider Stopping Treatment If There Is No Improvement over Time or If Your Condition Worsens

Rule 11. Do Not Go Home If You Do Not Feel OK

Rule 12. Take Action—Firmly and Courteously—If You Are Habitually Kept Waiting for Long Periods of Time Before You See Your Doctor

Rule 13. To Save Time (and Aggravation), Follow the “Call First” and “Schedule First” Tips

Rule 14. Before Seeing Your Doctor, Prepare a Short List of Questions

Rule 15. Resist the Urge to Talk during a Procedure or Examination

Rule 16. If You Become Involved in Legal Disputes, Remind Your Doctor’s Office to Protect Your Records

Rule 17. Educate Yourself on Doctors and Hospitals

Rule 18. In an Emergency That Requires Hospitalization, by Private Car or “911” Vehicle, Ask to Be Taken to a Full-Service Hospital

Rule 19. Consider Simple Research about Your Medical Problem or Medication

Rule 20. Evaluate Unsubstantiated Health and Medical Advice

Rule 21. In Your Home, Post Information about Doctors, Hospitals, and Medication

Rule 22. Keep Medical and Personal Information in Your Wallet

Rule 23. If Your HCP or Hospital Requires You to Sign an Arbitration Agreement, Sign It—and Don’t Worry!

Rule 24. Consider Joining a Medical Support Group

Rule 25. Create and Maintain Your Own Medical File

Rule 26. If You Discover an Error in Any Record, Ask for a Corrective Note

Rule 27. Obtain Your Original Records before Their “Destruct Date”

Rule 28. Ask for Written Instructions for Any Medication, Diet Change, or Exercise

Rule 29. Keep Each of Your Doctors Informed of Your Medications and Supplements

Rule 30. Be as Accurate as Possible When Providing the Doctor or Hospital with Essential Information

Rule 31. If There Is a Language Barrier, Bring Your Own Translator or Interpreter

Rule 32. Communicate Your Concerns to All Your Healthcare Providers; Do Not Assume They

Will Communicate with One Another



Chapter 2: Rules When Elective or Non-Emergency Surgery and Hospitalization Are First Considered: Rules 33–50

Rule 33. Ask Questions and Think Carefully Before You Agree to Have Surgery

Rule 34. If You Decide to Have Surgery, Take Steps to Assure the Best Possible Result

Rule 35. Avoid Traveling Far Away for a Surgery from the “Best” Expert

Rule 36. Verify with Your Surgeon That He or She Will Personally Perform the Surgery

Rule 37. Schedule Your Surgery at a Time When the Surgeon Will Be Available Seven Days Postoperatively

Rule 38. Schedule Your Elective Surgery for a Monday, Tuesday, or Wednesday Morning (If You Have a Choice)

Rule 39. Avoid Elective Surgery When Residents and Interns Change (June or July at Most Hospitals)

Rule 40. Ask Your Surgeon to Verify That Your Anesthesiologist Is a Board-Certified MD

Rule 41. Attempt to Have Your Surgery in a Full- Service Hospital

Rule 42. Arrange to Have an Advocate/Friend Remain in Your Hospital Room When Needed

Rule 43. Consider a Surgeon Who Is Skilled in a Particular Surgery, Even Though He or She Has a Reputation for Poor Aftercare

Rule 44. Select Your Surgeon Carefully: Investigate, Interview, and Decide

Rule 45. Don’t Panic If You Must Violate Some of Rules 36–43

Rule 46. Let Your Surgeon Select His or Her Own Method and Instruments of Surgery

Rule 47. Ask Your Surgeon If He or She Will Use a General or a Local Anesthetic and Whether You Have a Choice

Rule 48. Do Not Have Surgery on a Holiday or Weekend

Rule 49. Be Careful about Scheduling Surgery Only “to Avoid Losing Time from Work” If Such Scheduling Violates Other Rules

Rule 50. Let Your Surgeon Decide on the Number of Surgeries That Will Be Performed



Chapter 3: Rules Covering the Last Few Weeks before Planned Surgery: Rules 51–61

Rule 51. During the Weeks before Hospital Entry, Prepare, Assemble, and Learn How to Use Your “Hospital Kit”

Rule 52. A Day or Two before Hospital Entry, Use a Permanent Black Felt-Tip Marker to Print Warnings about Allergies and Body Surgery

Rule 53. Except for Your Hospital Kit, Leave Your Valuables at Home to Prevent Loss or Theft

Rule 54. If You Will Have a Private-Duty Nurse, Make Arrangements at Least a Week before Hospital Entry

Rule 55. Review Hospital Paperwork Seven to Ten Days before Entry

Rule 56. In the Weeks before Entry, Determine If a Hospitalist Will Be Available to See Patients

Rule 57. If You Are Ill before Your Elective or Non-Emergency Surgery, Ask Your Doctor about Possible Cancellation

Rule 58. Ask Your Doctor Which Medications You Should Be Taking or Discontinuing Before You Enter the Hospital

Rule 59. Ask Your Doctor’s Permission to Bring Your Own Medication to the Hospital Instead of Taking Those Supplied by the Hospital

Rule 60. Well before Surgery, Arrange for Postoperative Care

Rule 61. Verify That You Have Had a Preoperative Physical Examination



Chapter 4: Rules during Hospitalization: Rules 62–82

Rule 62. Have Your Friend/Advocate Help with the Check-in Procedure

Rule 63. Both You and Your Advocate Should Always Be Diplomatic, Friendly, and Cooperative with Everyone at the Hospital

Rule 64. Confirm That Your Hospital Wristband Has Your Correct Information

Rule 65. Right Away, Learn How to Work the Call Device and Other Equipment in Your Hospital Room

Rule 66. Promptly after Admission, Verify That Your Body Warning Signs and Other Printed Signs Are Placed and Visible

Rule 67. Before Surgery, Reconfirm Your Surgeon Will Be the One Performing the Surgery

Rule 68. Before Entering the Operating Room, Confirm Which Anesthetic Will Be Administered (Local or General)

Rule 69. Prior to Surgery, Tell Your Surgeon If You Have Removable Dentures, Implants, Stents, or Similar Items

Rule 70. Ask Your Doctor: “What Other Doctor Will Be Seeing Me during My Hospitalization?”

Rule 71. In the Hospital, Make Notes of Important Events to Include in Your Medical File

Rule 72. Before Taking Any Medication, Verify It Was Prescribed for You and Not Some Other Patient

Rule 73. If Your Room Has a Bedside Scanning Device to Check Medication, Make Sure It Is Used

Rule 74. If You Have a Serious Medical Problem, Insist on Being Seen by an Experienced MD; Do Not Allow a Delay Until Your Treating Doctor or Surgeon Returns

Rule 75. If You Discover That Doctors or Other Hospital Personnel Disagree with the Treatment You Are Receiving, Investigate and Consider a Second Opinion

Rule 76. When Tests Are Conducted, Always Ask Your Doctor, “What Did the Test Show?”

Rule 77. If Your Private-Duty Nurse Is Hostile, Incompetent, or Otherwise Unsatisfactory, Discharge Him or Her Promptly

Rule 78. Avoid Loss or Theft of Your Cell Phone or Smartphone

Rule 79. Ask Questions If You Discover Surgical or Other Treatment Complications

Rule 80. If You Are Cleared for Discharge but Feel Too Sick to Leave, Take Steps to Appeal So You Can Stay in the Hospital

Rule 81. Upon Discharge, Ask for Written Instructions about Medications or Other Required Action

Rule 82. Do Not Sign Any Documents When You Leave the Hospital



Chapter 5: Rules Covering Tests and Medical Devices: X-Rays, CT Scans, MRIs, Blood, Urine, and Other Tests: Rules 83–88 107

Rule 83. Ask Questions Before You Agree to Tests or Devices (See Exceptions)

Rule 84. Ask That All Tests Ordered by Your Doctor Be Conducted and Interpreted in the US (See Exceptions)

Rule 85. When Your Blood Is Taken for Testing, Check That Your Name Is on the Body of the Container

Rule 86. Whenever a Needle Is Used, Verify That It Is Taken from an Unopened and Sterile Package

Rule 87. Always Request Lead Shielding for Tests Involving Radiation (All X-rays and Scans)

Rule 88. If You Are Told to Use a Device, Have It Explained to You While You Are Still at the Office



Chapter 6: Rules concerning Medications and Prescriptions: Rules 89–96

Rule 89. Be Careful Buying Prescriptions by Mail or Online Pharmacies; Some Are Good, Some Are Bad, Some Are Fraudulent

Rule 90. Select Your Local Pharmacies Carefully; It Will Save Time and Money and Will Protect Your Health

Rule 91. If You Feel Sick or Have Another Problem When Starting New Medication, Stop Immediately and Contact Your Doctor

Rule 92. Check with Your Doctor about Taking, Continuing, or Stopping Medications

Rule 93. Verify That the Medication You Are Taking Was Prescribed by Your Doctor

Rule 94. Ask Your Doctor to Prescribe the Generic Unless There Are Good Reasons to Do Otherwise

Rule 95. Discard and Replace Outdated Medications

Rule 96. Do Not Give Children Adult Medication (See Exceptions)



Chapter 7: Financial and Insurance Issues: Rules 97–101

Rule 97. Maintain Medical, Hospital, and Drug Insurance

Rule 98. Verify in Advance That Your Bills Will Be Paid by Your Medical Plan

Rule 99. Reduce Out-of-Pocket Expenses by Bargaining, Coordinating, and Shopping

Rule 100. Whether You Have Insurance or Not, Learn to Financially Navigate Out-of-Pocket, Out-of-Network, and Concierge Medical Plans

Rule 101. Be Cautious Before Putting Other Medical or Laboratory Bills on Your Credit Card



Chapter 8: Medicolegal Issues: Rules 102–104

Rule 102. If Injury or Illness May Have Been Caused by Medical or Hospital Errors, or Other Causes, Take Steps to Protect Your Legal Rights

Rule 103. If Illness or Injury Occurs, as Discussed in

Rule 102, Decline Requests for “Interviews” or “Statements,” and Avoid Other Communications That May Compromise Your Legal Rights

Rule 104. Employ an Attorney ASAP If You Believe You Are a Victim of Medical or Hospital Error or Other Causes Discussed in Rule 102



Appendix A: Healthcare Providers (HCPs)

Appendix B: Hospitals and Other Facilities That Provide Similar Services: Emergency Rooms (ERs), Ambulatory Surgical Centers, Urgent Care, and Walk-in Clinics

Appendix C: Corrected Surgical Consent Form

Bibliography and Suggested Reading

About the Authors