Eric E. Kupersmith, M.D.: Carol, generally the surgeon will call or dictate a letter to the family doctor.  At times this may be done by a medical doctor who is involved during your stay.  What you can do to help is come prepared with the name, office number and address of your family doctor.  Also asking the surgeon up front is a great way of bringing this up.

Good luck with your husband's surgery!

Eric E. Kupersmith, M.D.: Paul,  the good news is that all the publicity over the last 10 years has led to huge changes across the nation regarding infection control and we have seen the rate of getting new infections decline.  Payors, Healthcare organizations, and patient advocacy groups have clearly aligned their interests which has driven the improvements.

Infection control programs at hospitals carefully monitor for contagious infections and these patients are put into private rooms Some hospitals are even moving towards single rooms for all patients.  Remember not all infections are contagious and sometimes we isolate patients who are not infected but are carriers (we call them "colonized") of organisms that can infect others.

Also the way we do certain procedures has changed and the usage of catheters and intravenous lines have changed to name a few more innovations in prevention. 

Proper hand hygiene is the single most important thing that can be done to prevent infections.  Your caregivers should wash their hands before and after working with you.  If you see them do this, saying "thanks for washing your hands" helps reinforce this behavior and lets them know you take infections seriously.  Hospitals now have soap or foam available in convenient locations which makes it easy for us to do.

Probably the easiest things you can do with the greatest impact is to ask "Do i need this IV or catheter?" and to acknowledge hand washing.

Overall Paul, the good news is that although all patients are at risk of getting an infection while in the hospital, with all the efforts going on i would hardly think you are a sitting duck!  It's probably more dangerous to drive a car - so always wear your seatbelt!

Eric E. Kupersmith, M.D.: Suzie, I understand that not knowing who is in charge is scary! And you are not alone. Many patients have this problem with doctors changing and figuring out who is in charge. This often brings up the question are the Docs talking to each other about your care? The good news is that it is not as unorganized as it may appear.

Let's go back in time.  The standard of a solo practitioner was that they saw you in the office and in the hospital and always remained in charge of your care.  But sometimes these docs took a day off for vacation or holidays.  When this happened somebody else "covered" for them and saw the hospitalized patients creating discontinuity with the patient's care.

Take this to the next step.  This solo doctor hires a partner.  Now they take alternate weeks in the hospital.  So now you may or may not ever see your doc, but at least you have his/her partner.

Finally, if this group has a busy office practice they can rarely find the time to stay in the hospital which usually leaves the majority of your care in the hands of very capable specialists (cardiologists, for example).

Sometimes, a person in the primary care group would say "I like hospital work better than office work" why don't I do it all the time?"  This led to your regular doctor staying in the office all the time and his partner at the hospital making sure you had the best care you could get.

However, many other things have happened to challenge the way we deliver care.  Patients have gotten sicker and older, technology has changed incredibly and the system has become more complicated.  A hospitalized patient's needs became harder to address by going back and forth to the hospital and required someone full time in the building.  Also, trying to ensure quality care 24 hours a day, 7 days a week pushed any one person to the limit. 

All these reasons have led the medical system to compartmentalize care by site.  You can see it in the development of Emergency Department Doctors, Critical Care doctors and now Hospital- based doctors (for admitted patients only).  Although it can lead to the feeling that your doctors aren't talking to each other, it really does provide for better outcomes for you and all our patients.

Why do we keep asking you the same questions?  We were all taught in medical school to take our own history.  This ensures that nothing is missed, and gives us a chance to get to know you.  How much "repeated" history is taken depends on the certainty of the diagnosis, the treatment plans and how much work is still required to help you through the system.

One doctor (usually a hospitalist or specialist) will contact your primary care doctor on admission and discharge and with any major events that occur while you are in the hospital.   This should help with getting to know you and your diagnoses as well as get your primary care doctor ready to see you for your first visit back.  These doctors, in every way, act as a surrogate partner to your primary care doctor.

Each hospital and physician group finds its preferred way of making sure safe continuity occurs while in the hospitals as well as providing communication to the family doctor.  There is no single way to do this and currently there are national efforts to standardize the way doctors are handing off patients within the hospital and to the primary care doctor. 
It's a long answer (and this is the short version!), but hopefully you understand that asking repeated questions DOES NOT mean the doctors don't know the key points of what's happening.  It's how we are trained and there are good reasons for it. Regarding what we can do about that to minimize the handoffs and different docs...we're still working on it!

Eric E. Kupersmith, M.D.: Pam, answers to both of your questions are variable based on why you are having the hysterectomy and what are those "normal activities"? If you are a marathon runner in great shape or someone with multiple medical problems, your length of stay in the hospital and your recovery will be very different.

Generally hysterectomies are considered routine and have very short hospitalizations with a good recovery over the first week and a return to even vigorous activity over a month.

It is extremely important that you discuss both these questions with your doctor to avoid complications and frustration.

Good luck!

Eric E. Kupersmith, M.D.: Dan, glad you asked! Hospitalists are similar to E.R. docs or critical care docs. Usually they are internists (but may be Family Practitioners or specialists) who have decided to devote their time to the practice of inpatient care. This means they do not do outpatient medicine and they spend the entire day in the hospital.

This increases the number of times you can see your doctor throughout the day, allows us to follow up on tests in real time, and increases our ability to communicate with other members of the health care team.

Hospitalists often co-manage patients with surgeons. In this role we take care of the medical problems and system issues and may serve as an advocate when things are not working efficiently. Depending on the situation we may act as the primary provider (despite being a surgical patient) or a consultant. In either role we can be a "liaison" with the Primary care doctor and the other members of the health care team.

Basically we'll do whatever needs to get done to get you the best care! Hope this helps clarify our roles.

Eric E. Kupersmith, M.D.: Hi Janet, that is a very important question. The answer is that there has been a shift away from the one doctor does it all to more of a team approach and compartmentalization of care.  If you refer to my answer to Suzie's question above, you will  find a more in depth discussion on the topic.

There is an expectation that the hospital doctors will speak with your family doctor and share important information.  In this way they are partnering to give you the best care possible.

Eric E. Kupersmith, M.D.: Tina, there are Patient Safety committees and reporting structures that each hospital has, and these work to continually improve and strive for 100% avoidance of preventable error.  The Joint Commission (TJC formerly JCAHO) is an organization that reviews hospital policies, procedures, and performance in these areas and is responsible for hospital accreditation.  Every few years hospitals are visited by TJC for an inspection and they identify areas of improvement and make recommendations. Cooper just received the highest accreditation from the TJC of three years.

It is up to each hospital to monitor, enforce, and improve.  At Cooper we have:

-Increased our use of electronic records

-A list of approved abbreviations

-Discourage verbal orders

If you read my earlier answer, I would recommend you give give positive reinforcement whenever you note your caregiver washing their hands. This is the number one item to reduce preventable infections and not only does your comment show them you appreciate it, it also lets them know that you take prevention seriously.

Secondly my big piece of advice is: keep your own notebook to record what you've been told and by whom. This will help keep things straight for you, but also may help keep everyone on the same page (if they are not already). 

For example, doctor X says you need gallbladder surgery and leaves. Doctor Y comes in and says you can go home. Are they communicating? It may be that they did not and you can intervene, or maybe they did and your surgery is to be done a few weeks later as an outpatient. These notebooks kept over time can be extremely helpful especially if you cross many medical systems.

Regarding what to look for: your caregivers should be courteous, engaged, welcoming of your questions, they should wash their hands, and be open minded to your needs.

Regarding what to ask: the most important questions while you are a patient should revolve around your diagnosis and treatment. For example: "What is my diagnosis? What's that for? How long will I need it? Do you have the final report of my x-ray? If you are concerned about a staff member following safety guidelines, you can ask to speak with the nurse in charge, the person with whom you have doubt or patient relations.

There is a great book by the IOM called "To Err is Human". Although 10 years old it actually breaks down the science of error and can really help empower you to understand the complexities.

Overall, the best thing to do is to work on strong lines of communication with your care team and keep asking questions.

Eric E. Kupersmith, M.D.: Mary Ann, wow have things changed since the 1970s!  The "rush" is generated by the fact that longer stays are associated with unnecessary medical complications, higher costs and that there is a serious problem with space for the number of people who need to be hospitalized.  Of course too short is also bad and leads to people having to come right back in!  The right balance is tricky but there are things you can do to minimize your risk and maximize your satisfaction with the decision (even if you leave quickly!).

First, when you are hospitalized, realize you are most likely going to be discharged when you are improved, not necessarily "all better" - as the saying goes.  In modern hospital medicine if we are providing a level of service that can be provided at home we will try to transition your ongoing care elsewhere (home, rehab).  For example if you have pneumonia and needed oxygen and were on intravenous antibiotics, and now you no longer need oxygen and can swallow pills - you may be able to go home, even if you are coughing and still feeling bad.

Second, start this dialogue early with your doctor.  Include in your discussions about your problem and treatment when they think you will be going home and talk with them about what you think you may need - home care, visiting nurses etc...There are many times people stay in the hospital for 1-2 days depending on what's wrong, so try not to be surprised.

Third, if you think it is unsafe for you to go home on the proposed day of discharge, bring it up.  This does not need to be a confrontation, rather an earnest discussion of your concerns.  Your doctor will work with you to make the final decision regarding if this is truly the right time for discharge.

Fourth, don't leave without a plan.  You should have written instructions that are legible (or typed) with follow-up explained.  If you don't have this, you should speak up.  It is our responsibility to work with you to ensure a safe transition out of the hospital.

Regarding coming right back in - being readmitted  or needing an E.R. visit - this is a widespread issue and there is a tremendous amount of work being done around the nation.  You can look up Project BOOST on the internet, which is an ongoing grant to the Society of Hospital Medicine looking to improve safety in the discharge process, as an example of how our nation is shifting its attention to this problem.

Getting through the health care system (whether in or out of the hospital) requires a team approach, and you should consider yourself the most important member of that team and keep a dialogue going at all times!