Hospitals can be scary places. All of us are anxious when we have to be hospitalized for an illness or surgical procedure. We feel a loss of control of our lives and are worried about risks and outcomes. We must place our trust in doctors and nurses who all too often are strangers. In the end it boils down to entering a hospital with your eyes wide open and trusting the doctor who will supervise your care. The following checklist itemizes the important issues you and your family should consider before, during and after your hospitalization.

Use a doctor who takes care of his or her own patients when they are hospitalized. Will the doctors who know you best be there for you when you need them the most? Surprisingly, more and more primary physicians transfer care to a hospital based doctor (hospitalist) who you have never met. Large groups and clinics do this routinely because hospital care is time consuming and poorly paid. Ask your doctor about his or her hospital practice.

Use a doctor who is familiar with your hospital, uses consultants appropriately and can get things done. Good physicians are familiar with hospital staff and departments, are not afraid to get consultants to help when needed, and take action when the going gets tough. Such a doctor is your best advocate.

Fully understand why you are going into a hospital and what is to be accomplished there. Ask questions. Who will see you every day? What tests will be done? Why must you have surgery? Etc.

In an emergency, if at all possible, choose a hospital where your physicians all work. Ask paramedics to take you to the hospital of your choice if they can.

In an emergency room, have your own doctor or the ER physician evaluate you. Emergency rooms are usually overloaded and overworked. Expect delays. Do not settle for evaluation only by a physician's assistant or nurse. Don't be shy about asking them to call your doctor right away. Your own doctor can either see you or direct the best consultant to your aid.

Bring a list of all your medicines or the pill bottles themselves to the hospital. If you have several doctors and multiple prescriptions, this is of great help to your doctor and nursing staff. However, never take your own pills in the hospital unless your doctor knows about it. The hospital expects to provide all of your medicines.

Never assume everyone knows you and your case or knows what they are doing. With nurses working fewer shifts, you will probably have a different RN each day. You will see more of nurses aides anyway. All are overworked. Your doctor will be the most consistent face you see and he or she will not be around much during the day. Be proactive with RNs and aides. Ask questions. If you cannot, your family needs to do so.

If your hospital's nursing is stretched too thin, consider hiring your own bedside help. It can be expensive but for certain illnesses or types of surgery it can be a great benefit. Ask your doctor's advice before you go in.

Have family at your bedside as much as possible. Sometimes you need an advocate or someone to communicate your special needs. Family is always best.

Keep a list of your daily hospital medicines and treatments at your bedside. Ask for it. The hospital has forms they use for this purpose and these can be at your bedside during your stay. Incorrect medicine administration is the commonest mistake hospitals make.

Communicate all questions and concerns immediately. If your nurse or aid cannot answer, ask to see the head nurse. Be pleasant but firm. You have a right to understand fully what is being done.

Ask for help when you need it. Don't be timid about asking for help to get to the bathroom or out of bed. Do not risk falling just to prove you can do it yourself.

Stay out of bed as much as possible. Ask to get up and out if your condition or surgery permits. The more you are up, the faster you demonstrate the ability to go home.

Ask to walk or ask for help to walk. Any serious illness or surgery leading to prolonged bed rest will weaken muscles and vascular tone. If you need physical therapy to get you on your feet, use it. The faster you do so, the sooner you go home.

Wear their gowns or your own clothes. Nothing is more dehumanizing that the hospital gown. No rule says you must always wear one, although at times it is more appropriate. Try jogging suits or your own single layer clothing if allowed. Ask.

Eat their food or bring in your own. Most hospital food is so bland it can lead to poor nutrition when you need food the most. Ask if your family can bring in your own food. Make sure it complies with the diet your doctor wants you to eat.

Ask for another opinion if you have doubts about treatment. A good doctor values your comfort level with his or her recommendations and welcomes another opinion. Be sure of your decision to proceed with surgery, chemotherapy or procedures carrying risk. Be sure the risk of doing nothing far outweighs the risk you are asked to accept with the recommended therapy.

Double check on new physicians or consultants. Ask your doctor or current consultants about any unfamiliar doctor. The nursing staff is also a good source of opinion even if they must be diplomatic. Be sure you are confident in all the physicians participating in your care.

Assess your home situation well before you leave the hospital. Be sure of your own ability and that of your family to care for your post hospital needs. If possible, ask your doctor about this before you enter the hospital.

Use hospital discharge planners to advise you about resources available under your insurance plan or Medicare. These hospital employees can speak to you or your family about equipment you may need, home health RNs who can visit you, aides who can come in on a temporary basis. Start early.

Use a post hospital nursing home if you must. Some patients really need prolonged nursing care that is best provided by a skilled nursing facility. Be sure you understand the goals of your nursing home stay, anticipated length of stay and who will direct your care at the facility you choose. Rely on your own doctor for the best advice.

Think about end of life issues and execute a Durable Power of Attorney for Healthcare Decisions. Discuss these issues with your family. Discuss them with your doctor. Designating a person to make decisions for you when you are unable to do so is a smart idea. This is the Durable Power of Attorney for Healthcare Decisions. Within it you can specify your medical treatment desires and limitations if you wish to do so. Be sure this document is on file with your primary physician and any other important specialist whom you see. In addition, there is a wallet card which you can keep designating the person with your Durable Power of Attorney for Healthcare.

Speak up, ask questions, complain when appropriate. No one who must be a hospital patient should assume a passive role in the hospital care process. Times have changed. Patients are expected to be informed and participate actively in their own care. Do not be afraid to do so.

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