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Book Reviews
The Hospital Survival Guide is an "insider's" guide to making the hospital system work for patients, primarily those having elective surgery. The first author, an anesthesiologist in the KP Mid-Atlantic Region, sees people coming to the hospital scared, uncomfortable, and feeling out of control--so he wrote this book to prepare them for their hospital visit. This book contains 297 pages and 11 chapters that discuss how to select a surgeon, then a hospital; how to get one's business in order (eg, how to obtain appropriate insurance and prepare a will); what to take (or not to take) to the hospital; and how to assertively express individual needs and concerns to ensure maximum safety of the hospital stay. The authors begin by suggesting that patients research their doctors by visiting various Internet Web sites listed in the book and that patients also question a sampling of people (doctors, nurses, and other patients) who have had experience with that physician. The authors discuss numerous considerations (eg, medical or surgical specialty, experience) and recommend that patients preparing for difficult surgery choose a specialist who has published research in medical journals, even if that specialist has a poor bedside manner. The authors feel that having a doctor who knows what he or she is doing is more important than how well they create warm and fuzzy feelings in the patient. Patients should be sure to get a second opinion, research Amazon.com for books and other Web sites to learn about the operative procedure, and possibly join a support group. If all these recommendations sound like a lot of work, consider: They form only the first chapter! Next, you have to pick a hospital: For this task, get ready for more Internet research and hospital tours. Although the numerous Web sites offered for research are handy, I wonder how many people have the motivation and resources to follow the recommendations. How does someone outside the medical profession arrange to interview other doctors, nurses, and patients to select a surgeon? The book seems to presume that patients have family or friends who had the same problem and that the same surgeon who treated them will be available. Not having surgery in July (when new medical and surgical residents begin residency training) or in the afternoon (when hospital shifts change) may be good advice, but what patients have that much control over when they get sick or when a surgeon schedules them for treatment? Instructions like these--along with anecdotes throughout the book showing how things can go wrong--may be more frightening than reassuring. For example, the book warns that if parents take their children to a general hospital instead of a pediatric hospital, the children may be intubated with a tube that is too large. The authors instruct patients that, once in the hospital, they should be assertive about such things as the kind of room desired (private) and who is permitted to draw the patient's blood (an experienced nurse, not a medical student). Some advice is valuable: For example, patients should keep a list of their medications. Don't be like the poor fellow who thought he took "Dick Johnson" for his heart! (He actually received digoxin.) Some advice (eg, not wearing nail polish or jewelry in the operating room) is correct but should already be known by the nurses getting a patient ready--even if the patient did not pick the best hospital! The book also contains some erroneous advice, eg, "write on yourself to mark the correct surgical site and also the opposite incorrect site." The latter marking may be distracting, confusing, or misunderstood--so patients should not do it. This book contains information that some hospital "insiders" may wish were more widely known. The book also contains an implication that if people knew more, they could prevent bad outcomes. Unfortunately, bad outcomes are portrayed in numerous anecdotes as being perpetrated by bad doctors. The retail
price for this paperback ($14.95) is midrange compared with similar books
listed on Amazon.com (search "personal health" or "health
care delivery"). For people unable to find this information with
their own Internet search, this book may provide a convenient means for
becoming informed and may help readers to assess whether they are satisfied
with the medical advice they have received from their own doctors.
Kenneth D Larsen, MD, PhD, is an anesthesiologist at the Kaiser Permanente Sunnyside Medical Center in Portland, Oregon. He holds a PhD in neurophysiology. E-mail: kenneth.larsen@kp.org.
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