In last month’s column ^[1], I took a look at risks patients face in hospitals, mostly from the perspective of “adverse events” – harmful, even fatal, occurrences that are unrelated to your underlying medical problem.  They occur in almost a third of admissions.

Kent Bradley, one of the commenters on last month’s column, rightly pointed out that on top of the adverse event numbers, you have to consider also medical errors – mistakes that are made in treating you.  So, he posted, “We’re running a much higher risk of harm.”

I passed on the comment to a former hospital chief operating officer I know, and his response was a short one:  “Oh yes.”

The column resulted in a fair amount of emails too that I exchanged with other multiple myeloma patients and caregivers about the need for a “self-preservation list.” Kent said such a list “would help us protect ourselves from all of the threats we face when we enter the hospital.”

I said to folks that I would try to develop one.  So, here’s a list of the top ten tips I came up with:

1. With apologies to Gershwin, you need someone to watch over you.  The best self-preservation tip I can think of is to have an advocate with you at all times — someone who will ask questions and speak up on your behalf.  Don’t ever think you can handle this by yourself.  There are just too many distractions when you are the patient for you to be able to keep on top of everything.

2. Question everything.  Ask why things are being done.  Don’t accept something like, “We’re sending you to radiology for an MRI to look at your whatever.”  If you just say OK to that, you’re going to wonder what they’re looking for and you won’t know anything until the next time you see your physician, which could be a full day later.  I know that this wouldn’t bother some people, but it should.

   For those ceaseless IV bags and bottles, ask what it is, why you are getting it, what it’s for, and who ordered it.  In one of my many hospital stays, I needed a blood transfusion and the nurse hooked me up.  In looking at the bag’s information, the blood type was different than mine, so we asked the nurse if that was all right.  She said, “Oh, they don’t make mistakes.”  Yes, she really said that.  Giving patients the wrong blood type, by the way, is one of the most common medical errors.  The nurse did reconsider what she’d said because she came back in the room a few minutes later and said she called down to the blood bank and was told the blood type was compatible with mine.

   Errors such as giving people the wrong infusion are less likely to happen with the advent and spread of electronic medical records systems, with bar codes and scanners.  But I wouldn’t get too comfortable thinking the problem has gone away.

3. Bring a laptop, netbook, or tablet.  A smartphone works too, if you have no other option.  This is not about staying in touch with the outside world and your friends.  You need to be able to access the Internet to get more information about what’s going on around you.  In the blood transfusion episode, for example, I was on my laptop checking on blood type compatibility and had an answer before the nurse came back.

   Access to the Internet gives you the ability to research, for example, those unfamiliar terms that get bandied about, and to check up on those unknown attending physicians and doctors who are liable to drop by.

4. Take notes.  This is a good job for your advocate/caregiver, but you should get in the habit of writing down your conversations with the medical staff about developments in your treatment.  In the hospital, a considerable amount of information often gets passed to you in a short time by doctors, and it’s easy to forget some of it.  Without notes, I guarantee there will be a moment when you’ll go:  What did they say about…?

5. Insist on a private room.  You’re a myeloma patient for goodness sake, and your immune system is likely lousy, especially if you’ve had a stem cell transplant.  Most hospitals understand your vulnerability, and they are also under an awful lot of pressure to cut an astonishing rate of hospital-acquired infections.  So your demand won’t fall on deaf ears.  You don’t need some other sick person in the room with you, and you don’t need their visitors, especially during flu season.  Your doctor should back you up on this.  Sometimes, you won’t get a private room and you’ll have to make the best of it.

6. Bring lots of disinfectant.  I don’t care what they tell you, hospital rooms aren’t all that clean nor germ-free.  Wipe down everything in sight.  Everyone I know who does this reports that the staff looks at them like they are crazy.  Ignore what the staff thinks – you’re right, and they are wrong.

7. Get on good terms with the nurses on your floor, and try to keep it that way.  As in any profession, there are good ones, and, um, not so good ones.  Don’t battle with the bad ones because you won’t win and they can make your life miserable when they are on duty.  If a nurse gives you what you know to be bad advice, ignore it.

   It’s important to understand that your nurse is your connection to the hospital bureaucracy.  They know their way around it, and, better still, they can navigate it and get to places you can’t.  Don’t be afraid to ask for his or her help.  Always remember that you are not your nurse’s only patient, but you are your only patient.

8. Check out the hospital before you go there.  You can do this at the Hospital Compare ^[2] website at the federal Department of Health and Human Services.  You should particularly check out the Process of Care Measures in the hospital’s profile.  This website will give you a good idea of how a hospital fares in a wide range of measures versus the rest of your state and the nation.

   Unfortunately, at this point Hospital Compare doesn’t provide MRSA (methicillin-resistant Staphylococcus aureus) data, but they are promising to add it.  Nobody wants to get MRSA, especially those of us with compromised immune systems.

   A Harris poll in late July found that we’re all concerned about hospital acquired infections:  75 percent of respondents believe lower infection rates are more important to consider than convenience for a hospital; 94 percent would prefer to go to a hospital that uses the latest technology available for preventing the spread of infection.

9. Bring your own clothes.  This may sound silly, but if you are in a hospital gown or hospital clothing all the time, you are at a disadvantage.  Your attire screams, “I am a patient.”  Changing into street clothes every morning says, on the other hand, “I may be a patient here, but I am also an individual and I should be treated on equal terms.”  It’s a subtle way of raising your image in the eyes of the staff.  It will also make you feel better.

10. One final thought.  Ask yourself, “Is this hospital admission really necessary?”  Most of the time, the answer, of course, will be yes.  There are going to be occasions, however, when the decision may be up to you.

    This happened to me this past winter when I had a nasty respiratory infection, but I was not particularly feverish.  (A temperature of 101-plus is the trump card for admission.)  I went back and forth with my doctor, who clearly leaned toward my going to the hospital but lacked an obvious clinical reason for admitting me.  I decided to get a prescription for a strong, oral antibiotic and promised to stay at home and rest.  Not exposing myself to the risks that abound in hospitals – particularly during flu season – entered into my decision-making.  I got better at home, and I was way more comfortable.

    Sometimes, you just have to say no.