Good Medicine

By Nissa Simon

An old saw says a hospital can be a dangerous place for a healthy person. Horror stories abound, from infectious bacteria lurking on every surface to medications mistakenly administered. If dangers like these make you worried, relax. From a simple procedure to more elaborate surgery, a few precautions can ensure a safe visit. You just need to know what to look for.

Take, for example, mistakes with medications. In 2002 about 500 hospitals and health-care facilities across the country reported almost 200,000 mistakes in prescribing and dispensing medicine, according to the United States Pharmacopeia, the organization that sets standards for prescription and nonprescription drugs. More than one-third of these mistakes involved adults 65 and older. "The average hospitalized patient in this age group gets between eight and 14 different medications every day," says Dr. Christine Cassell, president of the American Board of Internal Medicine. "It's not surprising that mistakes occur."

The Food and Drug Administration issued new regulations in February of this year requiring bar codes on commonly used prescription drugs. Hospitals using this technology provide patients with identification bracelets that have a scannable bar code. Before dispensing any medication, a nurse scans both the patient's bar code and the drug's bar code to verify that the patient is getting the right dose of the right drug. Hospitals have two years to comply with these regulations.

Today only about 2% of hospitals have this system in place. If the one you enter doesn't, request a list of every drug prescribed and find out what each one looks like. Don't be afraid to ask about an unfamiliar pill before swallowing it.

You also have to be vigilant about protecting yourself from infection. The Centers for Disease Control and Prevention (CDC) estimates that 2 million patients a year acquire infections while in the hospital, many of them carried on the unwashed hands of health-care workers. Although hand washing significantly reduces infection rates, the CDC notes that less than half of hospital personnel do this as they move from patient to patient. To make sure you're not handed an infection, remind all staff members (your doctor as well) to wash their hands before they touch you. "Visitors should also wash their hands, both when they come into the room and before they leave, so they don't carry germs in or out of the hospital," says Cassell.

The CDC recommends that if you have a urinary catheter inserted, you should be sure to ask how soon it can be removed. Although often necessary, catheters account for 40% of hospital-acquired infections. Your odds of developing an infection increase with each day a catheter is in place.

It's wise to avoid hospitals during the holiday season, when staffing is routinely skimpy. "The worst time is between mid-December and the first week in January," says Dr. Sherwin Nuland, clinical professor of surgery at Yale University. "That season's every bit as bad as mid-June to mid-July," when a new group of residents takes over.

Long gone are the days when you could go into a hospital and let others assume responsibility for your care. "As a patient, you have to make sure that you know the reason for everything that's being done, whether it's medication or an X ray or an intravenous line," Nuland says. "Remember the T shirts that said, QUESTION AUTHORITY? That's exactly what patients have to do."