In an earlier column, I suggested that you speak up when something just doesn't seem to be going right with the medical care you are receiving. But how do you do that?

Start by understanding two key points. First, it is okay for you to ask questions and expect to get answers that you can understand about what is happening to you. It's your life.

Second, big national organizations urge you to speak up. They believe that it is the right thing for you to do - and that your life may depend on your doing so. In other words, you are in good company if you ask questions when something seems to be going wrong.

For example, the Joint Commission accredits 18,000 hospitals and healthcare programs in the U.S. It has published more than 15 brochures in a series called "Speak Up." They have titles like "Help Avoid Mistakes in Your Surgery," "Help Avoid Mistakes with Your Medicines," "Help Prevent Medical Test Mistakes" and "Understanding Your Doctors and Other Caregivers." You can find these brochures online at

Think about this situation for a moment. Staff members of the Joint Commission spend their working lives behind the scenes in hospitals to check on the quality of care provided. And they are advising you to watch out for yourself and speak up.

A part of the U.S. government, the Agency for Healthcare Research and Quality, also offers brochures and podcasts that you can download or use online. Find these at An example of the brochures AHRQ offers is "Your Guide to Preventing and Treating Blood Clots." Blood clots are common side effects of hospital care, and kill five times as many people each year as breast cancer does.

What pointers should you keep in mind?

First, be as clear as possible about what alarms you. For example, "I am seeing two of everything" is more useful than "There is something wrong with my eyes." However, if you don't know what is wrong but you suddenly feel worse, it still makes sense to raise the alarm.

Second, know whom you are talking with. Dozens of people may enter your hospital room each day. You may not get the right attention if you complain only to the person who is there to pick up your menus or take you for a medical test. It is best to raise your concerns to a nurse or doctor. It is okay to ask "Are you a doctor?" or "Are you a nurse?" or to say "I need to speak with the person who is in charge of my care on this shift."

Third, try to treat people who are there to help you the way you would want to be treated. Sometimes, patients or their family members think that the best way to be heard is to shout and to be abusive. This approach rarely works. That is, if doctors and nurses hear angry attacks, they often stop thinking about the problem you are raising. Instead, they focus on your behavior.

If you are the patient, they may decide that you need to be sedated. If you are a family member, they may ask you to leave. As a result, the issue you were trying to point out may not get attention.

Fourth, ask to speak to the next person up the chain of command if necessary. For example, if you are having a problem with a nurse, ask to speak to the nurse supervisor. If a junior doctor (an intern or resident) doesn't seem to grasp the problem, ask to speak with the attending physician, who is more senior. If necessary, ask to speak to the most senior member of the hospital staff who is available. Sometimes senior staff members take turns being the administrator on call 24/7.

Fifth, when you check in, ask if the hospital has a patient ombudsman, a patient advocate, a patient relations department, or a rapid response team you can reach if you need to. Some hospitals have set up hotlines for patients and family members to call if they feel that a patient urgently needs attention that she is not getting.

Sixth, you might call your primary care doctor (from your hospital room) and ask for help dealing with the problem. Your doctor may have an easier time getting your concerns across to another doctor or nurse than you do.

Seventh, if none of these avenues work - and one of them should - you might try calling the hospital's risk management department from your hospital room. Ask to speak to a manager. The risk management department wants to ensure good patient care so that patients get good results and are happy with the hospital. That way, the risk of lawsuits is lower. On a related note, you might ask to speak with the quality control or quality improvement department.

By speaking up when something seems to be going wrong, you make it more likely that you will leave the hospital in good shape.