Before the Operation
The first thing that Bob needs is medical clearance. There are no exceptions. An internist has to take a complete medical history, conduct a physical examination, and run a series of tests: an electrocardiogram (EKG), a chest x-ray, a complete blood cell count and chemistry analysis, a blood test for clotting time, and a urine analysis.
If the examining physician leaves out any of these items, Bob could be in trouble. In addition, if Bob has a fever, the doctor must postpone the surgery at least until he identifies the source. This is done because the fever denotes an unknown place of infection that increases the risk of elective surgery to an unacceptable level.
Now Bob is ready to enter the hospital. He goes into a waiting room. A nurse comes out and brings him into her office to offer him some pre-op teaching. This is a good opportunity for him to mention the common errors covered in this book and ask about the current safety measures. If he does not get a pre-op teacher, he needs to insist on one because one should never enter the system without first getting a preoperative conference with a qualified nurse. If anyone tells Bob that the hospital does not provide preoperative conferences, he needs to go to the nursing office and ask to speak to the nursing director. I am certain that at this point the director will provide a qualified nurse to answer questions.