“For complex surgical procedures, you're generally better off at teaching hospitals, which usually stay at the forefront of health research. Medical students and residents ask questions, providing more eyes and ears to pay attention and prevent errors. Teaching hospitals have lower complication rates and better outcomes.”

—Evan Levine, MD, a cardiologist and the author of What Your Doctor Can't (or Won't) Tell You.

“Those freestanding ERs popping up all over? They typically don't have anywhere near the resources of hospital ERs, yet they cost just as much. Go there for small bumps and bruises. For something serious (chest pain, a badly broken bone), get to a trauma center where specialists and surgeons work.” 

—James Pinckney, MD, an ER doctor, founder of Diamond Physicians in Dallas, Texas. Check out these other 50 secrets an ER staff won't tell you.

Epidural steroid injections for back pain has risky potential complications like neurological problems or paralysis. “Generally, epidural steroid injection isn’t very useful for treatment of chronic back or neck pain,” says Steven Severyn, MD, an anesthesiologist at the Ohio State University Wexner Medical Center.

No unnecessary scans. Studies have shown that radiation from CT scans could be responsible for as many as two percent of all cancers in the U.S. “CT scans are much quicker and tend to be less costly than an MRI, but does have the added radiation that MRI’s lack,” says Todd Sontag, DO, a family medicine physician with Orlando Health.

Practically all surgeons have an inherent financial conflict of interest. That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively.” 

—James Rickert, MD, an orthopedic surgeon in Bedford, Indiana.

No-certified specialty. If an airline told you that their pilot is the best but he’s not FAA-certified, would you get on the plane? "For the same reason, always check if your surgeon is board-certified in his specialty. Many are not.” 

—Tomas A. Salerno, MD, chief of cardiothoracic surgery at the University of Miami Miller School of Medicine

Some surgeons won’t mention procedures they don’t know how to do. "I’ll see patients who were told they needed an open hysterectomy, even though it could be handled laparoscopically. That’s one reason it’s good to get a second opinion.” 

—Arnold Advincula, MD

Years ago, a patient sent his slides to three different pathologists and got three different answers. "I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab—not just one or two slides but the whole lot—and get a second interpretation.” 

—Bert Vorstman, MD, a prostate cancer specialist in Coral Springs, Florida

In medicine, you can get a DUI, go to jail for a couple of hours, and walk out at 7 a.m. the next morning and do a surgery. "You can be accused of sexual misconduct and drug and alcohol abuse in one state and pop over to the next one and get a license. Some state medical boards don’t even thoroughly research your background; they argue that the less-than-$10 fee to access national data is too expensive.” 

—Marty Makary, MD.

Surgeons are control freaks. "When things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.” 

—Paul Ruggieri, MD, author of Confessions of a Surgeon: The Good, the Bad, and the Complicated ... Life Behind the O.R. Doors

Mistakes are probably more common than you would think. "But most of them don’t actually hurt people. I work with residents, and I don’t let them do anything that I can’t fix if they screw it up. If there’s an error that I fix that I’m sure won’t affect the patient at all, I’m not going to say anything about it. That would accomplish nothing except to stress out the patient.” 

—An orthopedic surgeon

Some problems just don’t fix well with surgery, like many cases of back pain. "My advice? Grin and bear it. Some surgeons vehemently disagree. They say, ‘Oh, you have a degenerative disk, and that must be the culprit. Let’s fix it.’ But many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people.” 

—Kevin B. Jones, MD

Always ask about nonsurgical options and whether there’s anything wrong with waiting a little while. "Surgeons are busy, and they like to operate. A professor from my residency would say, ‘There is nothing more dangerous than a surgeon with an open operating room and a mortgage to pay.’” 

—Kevin B. Jones, MD

Talk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery. "Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there’s less chance of those reactions." 

—Kathy Magliato, MD, cardiothoracic surgeon at Saint John’s Health Center in Santa Monica, California

Residents have to learn how to operate, and it’s required that an attending physician be ‘present'. But ‘present’ doesn’t mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour." 

—Ezriel “Ed” Kornel, MD

During my six weeks as a surgical intern in the ER, I inadvertently stuck myself twice with contaminated needles...... briefly nodded off in the middle of suturing a leg laceration, accidentally punctured a guy’s femoral artery while trying to draw some blood, and broke up a fight between the family members of a guy who’d come in with a stab wound to the abdomen. I was slugged in the head by a delirious patient in an alcoholic rage, spat upon, coughed on, vomited on, farted on, bled on, and mistaken for an orderly.” 

—Paul Ruggieri, MD

Your doctor should not push you to make a speedy decision about prostate cancer surgery. "Most prostate cancers are extremely slow-growing, and there is so much misleading information out there, so you should take your time.” 

—Bert Vorstman, MD

If you have pain in your calf after surgery, or if it swells and looks red, call your doctor right away. "Those are the main symptoms of a blood clot, which is a risk of just about every surgery.” 

—James Rickert, MD

This is what really keeps us up at night. "It’s not making a mistake in the operating room; it’s the noncompliant patients. When patients don’t do what we tell them, bad things can happen.” 

—Kurian Thott, MD, an ob-gyn in Stafford, Virginia

Don’t ask too many questions. If you ask too many questions, you can be branded as a pain in the neck. "When one extremely hostile relative bombarded me every time I walked in, I developed a tendency not to go in the room. If you have three pages full of questions, show them to the nurse. Say ‘How many of these should I wait to ask the doctor about? How many can you help me with?’” 

—General surgeon who blogs under the name Skeptical Scalpel

About 25 percent of operations are unnecessary, but administrators e-mail doctors telling them to do more. "This is not an insurance company putting pressure on doctors; this is not a government regulation. This is private hospitals pushing doctors to generate more money by doing more procedures. It goes on at America’s top hospitals. The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do.” 

—Marty Makary, MD.

Fatigue and impatience have undoubtedly contributed to some mistakes I’ve made in the operating room. "But unless you ask, your surgeon is not going to tell you that he was up all night on call before your procedure and that he may not be in tip-top form.” 

—Paul Ruggieri, MD

I always ask at national conferences of doctors, ‘How many of you know of another doctor who should not be practicing medicine because he is too dangerous?’ "Every hand goes up.” 

—Marty Makary, MD

Very often, plastic surgery patients don’t admit to a previous surgery, and I don’t find out until I’m in there. "I’ll go in on an eyelid or a nose, and it’s just a mess. If you don’t tell us you had lipo, there will be scar tissue, and the fat won’t come out normally. So please be 100 percent honest. There’s no need to be embarrassed. We’ve heard it all, and we don’t judge.” 

—Andrew Ordon, MD, cohost of the television show The Doctors and a board-certified plastic surgeon.

The biggest mistake during recovery is not giving yourself enough of a break. "Give yourself time to heal. If you don’t, you can cause complications and prolong your recovery."

—Andrew Ordon, MD

If your doctor wants to give you a stent, always ask: Is this better than medicine? "If you’re not having a heart attack or an unstable angina, you will do equally well with a stent or medicine, studies show. Having something permanently implanted in your body is not a risk-free proposition. There is evidence that thousands of people have had stents they likely did not need." 

—Marc Gillinov, MD.

If I had any kind of serious medical condition, I’d go to a teaching hospital. "You’ll get doctors involved with the latest in medicine. Even for simple cases, if there’s a complication that requires an assist device or a heart transplant, some hospitals may not be able to do it. At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available." 

—Tomas A. Salerno, MD

Before any operation, always ask what’s broken and how fixing it will help. "Just because you have a blockage in an artery doesn’t mean you need it fixed, especially if you don’t have symptoms.” 

—Marc Gillinov, MD

Specialists quietly pad your bill. “Less-well-trained physicians will call in an abundance of consults to help them take care of the patient. If those specialists check on you every day, your bill is being padded and padded. Ask whether those daily visits are necessary.” 

—Evan Levine, MD.

Ask how to recover faster. “Since each day in the hospital costs $4,293 on average, one of the best ways to cut costs is to get out sooner. Find out what criteria you need to meet to be discharged, and then get motivated, whether it’s moving from the bed to a chair or walking two laps around the hospital floor.” 

—James Pinckney, MD.

Second-guess tests. “Fifteen to 30 percent of everything we do—tests, medications, and procedures—is unnecessary, our research has shown. It’s partly because of patient demand; it’s partly to prevent malpractice. When your doctor orders a test, ask why, what he expects to learn, and how your care will change if you don’t have it.”

 —Marty Makary, MD.

“Your surgeon may be doing someone else’s surgery at the same time as yours. We’re talking about complex, long, highly skilled operations that are scheduled completely concurrently, so your surgeon is not present for half of yours or more. Many of us have been concerned about this for decades. Ask about it beforehand.” 

—Marty Makary, MD.

“Hospital toiletries are awful. The lotion is watery. The bars of soap are so harsh that they dry out your skin. There is no conditioner. The toilet paper is not the softest. Come with your own.” 

—Michele Curtis, MD.

Being transferred? Speak up. “If you go to a smaller hospital and it has to transfer you to a different medical center, demand that it ship you to the closest one that can handle your care. What’s happening is that community medical centers are sending patients instead to the big hospital that they’re affiliated with, even if it’s farther away. It happens even when a patient is bleeding to death or having a heart attack that needs emergency care.” 

—Evan Levine, MD.

“Don’t assume the food is what you should be eating. There’s no communication between dietary and pharmacy, and that can be a problem when you’re on certain meds. I’ve had patients on drugs for hypertension or heart failure (which raises potassium levels), and the hospital is delivering (potassium-rich) bananas and orange juice. Then their potassium goes sky high, and I have to stop the meds. Ask your doctor whether there are foods you should avoid.” 

—Evan Levine, MD.

On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other diagnostic services may be unavailable. If you’re having a major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend. 

—Roy Benaroch, MD, a pediatrician and the author of A Guide to Getting the Best Healthcare for Your Child.

“Many hospitals say no drinking or eating after midnight the day before your surgery because it’s more convenient for them. But that means patients may show up uncomfortable, dehydrated, and starving, especially for afternoon surgery. The latest American Society of Anesthesiologists guidelines are more nuanced: no fried or fatty foods for eight hours before your surgery and no food at all for six hours. Clear liquids, including water, fruit juices without pulp, soda, Gatorade, and black coffee, may be consumed up to two hours beforehand.” 

—Cynthia Wong, MD, an anesthesiologist at University of Iowa Healthcare

“Get copies of your labs, tests, and scans before you leave the hospital, along with your discharge summary and operative report if you had surgery. It can be shockingly difficult for me to get copies of those things. Even though I have a computer and the hospital has a computer, our computers don’t talk to each other.” 

—Roy Benaroch, MD.

“One time, I ran into a patient I had performed a simple appendectomy on. He thanked me for saving his life, then told me it almost ruined him because he couldn’t pay the bill. Four hours in the hospital, and they charged him $12,000, and that didn’t even include my fee. I showed his bill to some other doctors. We took out an ad in the newspaper demanding change.” 

—Hans Rechsteiner, MD, a general surgeon in northern Wisconsin.

We're Impatient. Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?" 
—James Dillard, MD

Ninety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making. Internist, Rochester, Minnesota Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest. 
—Internist, Philadelphia

Doctors get paid each time they visit their patients in the hospital,so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten.

—Evan S. Levine, MD

60% of doctors don't follow hand-washing guidelines. 

Source: CDC Morbidity and Mortality Weekly Report

96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...

94% of doctors have accepted some kind of freebie from a drug company. 
Source: New England Journal of Medicine

58% doctors would give adolescents contraceptives without parental consent. 

Source: New England Journal of Medicine

Your doctor or nurse may have messed up your meds.

Doctors in training look the same as doctors in charge.

Your medical records are not confidential. If your charts are an open book, it boosts the odds that sensitive details about your health will slip into the hands of people who could use them against you—employers, ex-spouses, or medical identity thieves, says Deborah Peel, M.D., founder and chairwoman of the nonprofit advocacy group Patient Privacy Rights.

Your doctor's hands may be filthy.

Toronto doctor reveals secrets of hospital slang. Obese patients are “whales” or “beemers”. Old people are known as FTDs, or “failure to die”

ER doctors want you to know ER is just like a horror movie. At first you're excited for every day, then there's lots of blood and screaming and crying and it's terrifying. And there's plenty of riddles, like, 'What exactly did you shove up there?!'" It takes an entire team to make an ER run. They work around the clock with little to no breaks. They care about you and they will fight for you.

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