The other day I was reviewing my mail from the APHA (Alliances of Professional Health Associates) of which I am a member, and came across the 50 Secrets Your Hospital Won’t Tell You by Reader’s Digest. It made me think, mmm, what would my list be for Israeli hospitals?
So here are my top 10 secrets Israeli hospitals won’t tell you, but you should know:
1. You can ask the nurse and doctor to put on gloves, even when doing simple procedures, including taking blood. Wearing gloves is one of the mandates of any certified hospital and all staff knows that wearing gloves reduces infections. Don’t feel embarrassed or act horrified, just smile and ask nicely.
2. The hospital is required to provide a translator for you. We’ve all heard the line, ‘Everyone speaks English’ but sometimes the specialist, or whomever, does not and you feel that you have no idea what they are telling you. Request firmly that the staff find someone who you can understand.
3. You are allowed to refuse any treatment you choose. If you feel unsure about a treatment or you have decided not to do it for whatever reason, you are completely allowed to refuse. You complete a form that declares you are refusing treatment Against Medical Advice (AMA), take that form and leave. You should not be bullied, cajoled, or manipulated into choosing a treatment that you do not want. You can also ask the doctor if there are any other types of treatment/interventions available. Often, they will not have thought to mention something that may be more relevant for you.
4. Not all Ambulance rides are covered by the Kupah. Only in the following emergencies: you are admitted to the hospital after diagnosis in the ER, you are having a heart attack, you are unconscious, you have been in a car accident, you were transported in an ICU ambulance, oncology or dialysis patients, and a woman in labor if she gives birth within three days of her being in the hospital, if she is within 24 hours of giving birth in her home, and stays in the hospital for at least 12 hours. However, after the fact, if you are charged, you may go to the head kupah office and ask to be covered, citing ignorance and explaining your reasoning. Often, you will get it covered.
5. You must receive a referral from a doctor to go the ER, unless you meet the criteria from #4. Doctors are available either through the extended kupah clinic hours in all major cities or in some areas, Terem. Have the hours of nearby clinics on hand, in case of emergency.
Between midnight and 7 a.m. most clinics are not open, so you may go to the ER without a referral. If you are charged, go in to see the kupah administration anyway; often they will cover you, after the fact.
6. Not all drugs are covered in the ‘basket of services’. If the doctor in the hospital gives you a prescription for a new drug after discharge, find out by your kupah if it is covered. Ask the kupah secretary; the doctor often will not know. You may get special permission to get that drug all or partially covered, but you need to get permission from the Drug Approval Committee.
This requires a special form to be completed by the doctor, Tofes 29, along with the medical summary explaining the need for the medication. This often happens when you have made Aliyah and are used to specific medications. Investigate your options but if you are reluctant to take the generic for any medical reason, or this new medication is crucial for you, apply to get permission. This process usually takes several weeks, and you can only purchase the medication after the permit is registered in the kupah computer system.
7. Nurses are overwhelmed. This one is taken directly from the Reader’s Digest list. Israel has a shortage of nurses, and each nurse has an almost impossible amount of work to complete each shift. Be kind but firm with your needs. And take someone with you. No patient should ever be left alone in the hospital for more than a few hours at a time. Nurses are busy and basic patient needs like an extra pillow, a blanket, going to the bathroom, adjustments, are not first priority. So make sure you, or someone you trust, is present. This is also an extremely kind action to do for a friend as well.
8. Get your papers right away. This one is also from the RD list. It is crucial to leave the hospital with all blood test results, medication provided, and the discharge letter from the hospital. This information is important to follow up later and your family doctor does not receive a copy or have access to this info. If a specialist has seen you and recommends further testing or treatment, make sure this is stated clearly in the discharge letter. You will need a referral from your family doctor or a kupah specialist, and they will only give it if they see a referral in writing from the hospital. Try to show this discharge letter to your family doctor as soon as possible to find out if you will need additional information, or special permission to do that test.
9. The pain medication you received so freely in the hospital may not be available when you get home. Pain is relative and people respond differently to surgery and physical trauma. There are pain management protocols in place in the hospital and the staff are familiar with them, but no one, but you, will manage your pain at home. Make sure you leave with a prescription for strong pain relief (like percoset, morphine derivatives, optalgin), to give to your family doctor, (because your family doctor, again, will need to give you the actual prescription to take to the pharmacy and be covered). You need to have a discussion with the physician in the hospital, or your family doctor, to create a pain management program that will work for you.
10. Timing is everything in the hospital. Morning rounds are essential to accelerate communication between doctors, for you to ask your questions. If you wander off during that time, to have a visit or buy something to eat, you may be put to the back of the line. Rounds start anywhere from 7 to 10 so pay attention to what’s going on around but don’t plan to leave for long during that time.
Also, shift changes occur between 7 a.m., 3 pm. and 11 p.m. Try not to ask for important information from the nurse during that time because s/he may forget in the swoop of transitioning to the incoming staff; if you have flexibility as to when to arrive to be admitted, like in labor, or coming from Terem, try not to arrive within ½ hour of these times. You will be very happy in retrospect.