This is the first advice you hear from many doctors, nurses and other health professionals when you ask them, "What's the best way to survive a stay in the hospital?"
The advice is of course part sardonic, but also part realistic.
It is realistic because, in addition to the successes and even wonders that are achieved in modern hospitals, there are unnecessary operations, adverse drug reactions, harmful and even fatal blunders and infections caused by germs that grow richly in the hospital environment.
The advice is realistic, too, because you may find that hospitalization is not really necessary if you think hard about it, or talk the situation over carefully with your doctor. And if surgery, or even some kinds of nonsurgical stays, are suggested, a second opinion before you decide may show it's not needed.
"In the last three years, two women have called to say a doctor said they needed immediate surgery to remove a large tumor on an ovary," Dr. Sidney Wolfe, head of the Ralph Nader-founded Health Research Group, reported. "I took their histories and thought they might have the kind of ovarian cyst that sometimes waxes and wanes. So I referred them to a fine gynecologist, and that was the case. In a few weeks both masses had all but disappeared."
"I was just looking at the rates at which hospital patients acquire infections they didn't have when they entered the hospital," said Dr. John Johnson of the Kaiser medical organization. "I'll tell you what -- I think the best way to survive is to work it out so you don't have to go."
"Hospitals are dangerous places," said Dr. Eugene Robin, a Stanford University medical professor and practicing physician at Stanford's own noted hospital. "Before I'd go into the hospital, I'd have to make certain I was truly ill and the hospital was the only place to provide the treatment."
There is no doubt that you may have to go to a hospital if you are seriously ill or hurt.
There is no doubt, in that case, that your chance of being helped is far greater than your chance of being harmed -- assuming you're in a good hospital with good doctors and other staff.
There is no doubt, too, that we need hospitals. We, the smashed up victims of auto or motorcycle accidents, the heart attack and stroke victims, the severely infected, the faltering aged, the vulnerable infants, need them to preserve our lives. We need them to deliver our babies and ease our passing. They are our places of both life and death, and before they were invented -- a matter of only the last few hundred years in any modern sense -- the experience of serious illness was immeasurably meaner.
In the next 12 months, one American in seven, and someone in two families in three, will need a hospital bed.
"We're the people who have to do it for you," said J. Stephen Lindsey, a Richmond hospital administrator. "We're the ones who have to take care of you when you show up in the emergency room at 2 o'clock in the morning. We're the people who have to be ready."
This demands a large and complex array of skilled people, and it demands sophisticated technology, operated by what is often a barely sufficient force working around the clock to care for the very sick who need this kind of care.
Once upon a time, even 10 or 20 years ago, you would hear someone say, "I'm going to the hospital for a rest."
"I have been a frequent patient in hospitals . . . But hospitals are nothing like home," the noted baby doctor, Benjamin Spock, wrote in Parade magazine recently. "They are more like factories -- clean, modern factories to produce diagnoses and treatments.
"A stream of staffers barges in, as if from outer space: history takers, physical examiners, temperature and pulse takers, meal servers, bath givers, bed makers, pill pushers, specimen takers. Not one of them primarily interested in the person, of course."
For all of Spock's fame, that is not quite everybody's experience. Hospitals have many concerned and caring people among the "pushers" and "takers" he lists. They also have many busy, preoccupied, often weary people and many who become unfortunately calloused and cold, an emotional defense against the sight of mishap and death.
"A hospital is a huge bureaucracy driven by the values set on life-saving," said Dr. Heather Palmer of the Harvard School of Public Health. "It tends to be a fairly standardized and regimented place, just to get the work done.
"The people who work in it have their own needs and their own problems. So someone suddenly arrives to draw blood and you didn't know anything about it.
"It's easy to feel like an object. I know. I've been a patient."
Hospitals are under still another kind of constraint today. National and local governments, health insurors and employers are limiting the amount of money they will pay for hospital care. Hospital use has been going down, and hospitals have been laying off nurses and other workers and in many cases forcing those who are left to care for more patients.
This makes it more likely than ever that you'll have to wait when you call for a nurse.
Far more serious are the "inadvertent," "inappropriate" and "erroneous" events that result in a hospital's "adverse outcomes": the hospital-acquired infections and unfortunate drug reactions, the after-effects of botched treatments and operations and the human mistakes.
On Jan. 27, a 20-month-old boy died at the National Institutes of Health in Bethesda when he was mistakenly given a saline solution five times stronger than the doctor ordered. On Feb. 27, a pregnant Albany, N.Y., woman with cancer was paralyzed and her baby died after an anticancer drug was mistakenly injected into her spine. On March 1 a Florida man died during cancer surgery when a deadly chemical was mistakenly injected into his spinal column.
Many of these events are avoidable. But in any setting where human beings wield complex technologies, some will always occur.
"Don't go to the hospital if you don't have to, and make sure you have to," Dr. Wolfe advised.
"You run a number of risks. You lose contact with your family. You lose time from work. You may spend a lot of money, even with insurance."
How can you stay out of the hospital?
How can you improve your chances if you must be hospitalized?
Consider -- and save for future need -- the ideas on these pages.